{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:59:36Z","timestamp":1780639176605,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["A11264n"],"award-info":[{"award-number":["A11264n"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH112\u20102M35"],"award-info":[{"award-number":["KMUH112\u20102M35"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH110\u20100M47"],"award-info":[{"award-number":["KMUH110\u20100M47"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Diabetic retinopathy (DR) is a leading cause of vision impairment in patients diagnosed with Type 2 diabetes mellitus (T2DM). Awareness of risk factors is necessary to reduce or prevent harmful effects of DR such as irreversible vision loss, and to help ensure early treatment. This study aimed to evaluate associations between initial HbA1c at diabetes diagnosis, longitudinal changes, and medication adherence (MR), and the severity and progression of sight\u2010threatening diabetic retinopathy (STDR). From July 2022 to January 2024, 300 patients with T2DM aged \u2265\u200920\u2009years were recruited, and the data of 178 patients with complete data were analyzed, focusing on initial HbA1c levels at DM diagnosis, subsequent HbA1c changes at ophthalmologic visits, and MR using the Taiwanese version of the Morisky Medication Adherence Scale\u20108 (MMAS\u20108). Patients with persistently high or fluctuating HbA1c levels had a higher risk of severe DR compared to those with consistently low HbA1c. High initial HbA1c was more strongly associated with DR severity in females, patients aged &lt;\u200965\u2009years, and those without diet or exercise control. Poor or moderate MR was associated with higher HbA1c at follow\u2010up and increased STDR risk. In contrast, patients aged \u2265\u200965\u2009years were less likely to develop severe DR. Findings of this study accentuate the importance of initial glycemic control and HbA1c trends during ophthalmologic care in managing DR progression, suggesting that patients with high initial HbA1c may benefit from closer early ophthalmic monitoring.<\/jats:p>","DOI":"10.1002\/kjm2.70148","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:06:47Z","timestamp":1765962407000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations Between Initial Glycated Hemoglobin at Diabetes Diagnosis, Longitudinal Changes and Medication Effects, and the Severity and Progression of Sight\u2010Threatening Diabetic Retinopathy"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3068-4434","authenticated-orcid":false,"given":"Yu\u2010Chi","family":"Sung","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Ophthalmology, School of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Kuang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Ophthalmology, School of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching\u2010An","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Ophthalmology, School of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6417-4363","authenticated-orcid":false,"given":"Pei\u2010Kang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Ophthalmology, School of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1240-4219","authenticated-orcid":false,"given":"Kai\u2010Chun","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Ophthalmology, School of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Shan","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Medical Statistics and Bioinformatics, Department of Medical Research Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Li","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Min","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Division of Medical Statistics and Bioinformatics, Department of Medical Research Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Public Health Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Center for Big Data Research Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2644-2475","authenticated-orcid":false,"given":"Shwu\u2010Jiuan","family":"Sheu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Ophthalmology, School of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2012.68"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/157940"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7258.405"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11102761"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2017.03.011"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011807"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-014-0515-z"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtumed.2016.12.006"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S350867"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-30740-y"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apjo.2024.100109"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-024-03665-6"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016280"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.12804"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jecm.2013.02.005"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-024-02328-8"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-1834"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12267-2"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xops.2023.100291"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-2308"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2008.08.023"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2112"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.1999.00092.x"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2018.07.157"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3586"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15213"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13538"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/5539654"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3214"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-9071.2011.02599.x"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2014.162"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70137-8"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/0091270010382911"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2098"},{"issue":"3","key":"e_1_2_12_36_1","first-page":"159","article-title":"Medication Adherence to Type 2 Diabetic Patients Hospitalized at a Tertiary Care Hospital in Bangladesh: Diabetic Medication Adherence","volume":"9","author":"Rana M. M.","year":"2019","journal-title":"Journal of Health Science"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-98488-6"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-020-0278-5"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229665"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000019236"},{"issue":"10","key":"e_1_2_12_41_1","article-title":"Prevalence and Risk Factors of Retinopathy in Type 1 Diabetes: A Cross\u2010Sectional Study","volume":"15","author":"Berrabeh S.","year":"2023","journal-title":"Cureus"}],"container-title":["The Kaohsiung Journal of Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70148","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/kjm2.70148","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70148","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:00:50Z","timestamp":1780635650000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/kjm2.70148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/kjm2.70148"],"URL":"https:\/\/doi.org\/10.1002\/kjm2.70148","archive":["Portico"],"relation":{},"ISSN":["1607-551X","2410-8650"],"issn-type":[{"value":"1607-551X","type":"print"},{"value":"2410-8650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]},"assertion":[{"value":"2025-04-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70148"}}