GLYCEMIC VARIABILITY AND PROGRESSION OF DIABETIC RETINOPATHY: A NARRATIVE REVIEW OF THE LITERATURE

Abstract

This study analyzes the relationship between glycemic variability and the progression of diabetic retinopathy, a major microvascular complication of diabetes mellitus and a leading cause of preventable vision loss in adults. The investigation is grounded in pathophysiological aspects of the disease and the effects of glucose fluctuations on retinal microcirculation, including mechanisms such as oxidative stress, chronic inflammation, endothelial dysfunction, and tissue hypoxia. A literature integrative review with a qualitative approach was conducted, based on studies retrieved from the PubMed database and complemented by manual selection of relevant literature. Four studies with different methodological designs were analyzed, including a meta-analysis, a prospective cohort study, a systematic review with meta-analysis, and an integrative review. The findings demonstrate that greater glycemic variability is associated with an increased risk of developing and progressing diabetic retinopathy. Indicators such as the standard deviation and coefficient of variation of glycated hemoglobin (HbA1c) were associated with retinal microvascular alterations and higher disease incidence. These results suggest that glycemic variability is a relevant factor in the pathophysiology of diabetic retinopathy, highlighting the importance of metabolic control strategies that consider not only average glycemic levels but also glucose stability over time.