Rapid progression of diabetic retinopathy
(often caused by sudden lowering of the HbA1c)

David Kinshuck



If HbA1c drops ~30 mmols/l 3% retinopathy can drastically progress. Here are 4 cases & references. A patient without any retinopathy will generally benefit from the improvement in diabetic control. But if a patient has early retinopathy and then improves their diabetic control HbA1c 30 mmols/l 3% problems may develop.

If this happens more laser is needed if there is space, otherwise anti-VEGF injectionsare needed.

In Liverpool 2007 4 cases were presented by Mr D.F. :

In Manchester 2011 Prof Harding recommended that patients whose HbA1c was very high eg 96mmol/l 11% , with very active retinopathy, bring their level down by 1% each year. But this seems far too slow to me....the slow reduction will help the eyes, but not prevent the other diabetic complications.

Sometimes the retinopathy progresses quickly if blood pressure rises or/and kidney function reduces.


Case 1

Case 2

Case 3

Case 4

Case 5