In a district that has operated retinal screening since 1986, diabetic retinopathy was not the commonest cause of blindness in the working age population, consistent with an effect of systematic annual screening.

Aims/hypothesis Pregnancy in type 1 diabetic women is associated with risk of worsening of retinopathy. It has been reported that deterioration continues in the months after delivery, but direct data are lacking. It is also unclear what impact pregnancy has on the long-term progression of retinopathy. Methods We studied 59 women with type 1 diabetes who had retinal photographs before pregnancy and yearly for 5 years post pregnancy. These photographs were graded using the EURODIAB retinopathy grading system. Results The mean duration of diabetes was 14.4±8.2 years and mean age at pregnancy was 29.8±5.5 years. Mean HbA 1c was 8.2±2.0% before pregnancy with tighter control during pregnancy itself. This value was high despite efforts to improve take-up of pre-conception care. Mean HbA 1c was 8.6±1.5 during the follow-up period. At baseline, 43 (72.9%) women were free of retinopathy, 15 had nonproliferative retinopathy and one woman had previously had laser therapy. During pregnancy four women required laser therapy. Over the next 5 years none required laser therapy, although retinopathy worsened in 14 women. Tenyear follow-up data were available on 22 women, one of whom required laser therapy 8 years after pregnancy. Baseline retinopathy status was the only independent risk factor which predicted progression of retinopathy. Conclusions/interpretation Pregnancy is not associated with post-partum worsening of retinopathy.

In Newcastle district, where the retinal screening programme has been running since 1986, the rates of blindness and partial sightedness are less than one-third of those reported in the surveys prior to 1997, confirming that objectives of the St Vincent's declarations are being achieved.

Aims/hypothesis. Universal worsening of retinopathy after starting insulin therapy in Type 2 diabetes has been suggested in previous work. Methods. We studied 294 such patients for up to 5 years to evaluate retinal changes and define the factors affecting progression of retinopathy. Yearly retinal photographs were graded using the EURODIAB system. Results. Prior to insulin therapy, 26.2% (77/294) of the patients had minimal non-proliferative diabetic retinopathy (NPDR), 3.7% (n=11) had moderate NPDR and 1% (n=3) had severe NPDR. Over the first 3 years of insulin therapy, significant progression occurred in 36 subjects (12.6%). This comprised 5/193 (2.6%) without any retinopathy at baseline, 22/77 (28.5%) with minimal NPDR and 6/11 with moderate NPDR (54.5%) (χ 2 =56.1, p<0.001). In a control group of 70 patients who remained on oral hypoglycaemic agents, nine patients had significant worsening of retinopathy over 3 years. Over 5 years, 22/127 (17.3%) of patients (9/95 without and 13/32 with retinopathy at baseline [χ 2 =16.2, p<0.001]) had significant progression of retinopathy. Higher baseline HbA 1 c (p=0.002) and lower initial decrease in HbA 1 c (p=0.007) were each independent predictors of greater retinopathy progression over this period. There was no significant worsening of visual acuity in patients whose retinopathy progressed. Conclusions/interpretation. After initiation of insulin treatment in Type 2 diabetes, clinically significant worsening of retinopathy over a 3-year period was uncommon in those with no retinopathy (2.6%) but occurred in 31.8% of patients with any retinopathy at baseline. The risk of serious worsening of retinopathy after insulin therapy is started in all patients with Type 2 diabetes may have been previously overestimated.