HbA1C and Diabetic Retinopathy exhibit Inverted U-Shaped Relationship, reveals research

This nonlinear association suggests that while moderate elevations in HbA1c are associated with increased DR risk, extremely high HbA1c levels may not correspond to a proportional increase in risk.

The authors hypothesize that this pattern may be due to factors such as metabolic memory, where prolonged hyperglycemia leads to irreversible microvascular damage, and the plateauing effects of chronic oxidative stress and inflammation at very high HbA1c levels.

The study's findings have important implications for clinical practice and public health policy. Regular screening and early intervention for diabetic patients, particularly those with HbA1c levels approaching 9.4%, are crucial for preventing the progression of DR. Healthcare providers are encouraged to monitor HbA1c levels closely and consider personalized management strategies to mitigate the risk of DR across diverse populations.

Reference:

Ling, J., Xie, Z., Chen, X., et al. (2025). Inverted U-shaped relationship between HbA1c and diabetic retinopathy in diabetic patients: a cross-sectional study. BMC Ophthalmology, 25, Article 289. https://doi.org/10.1186/s12886-025-04079-8