A Controlled Study of the Influence of Continuous Subcutaneous Insulin Infusion Treatment on Diabetic Retinopathy during Pregnancy

Abstract

ABSTRACT. Laatikainen L, Teramo K, Hieta‐Heikurainen H, Koivisto V, Pelkonen R (Department of Ophthalmology, I and II Departments of Obstetrics and Gynaecology, III Department of Medicine, Helsinki University Hospital, Helsinki, Finland). A controlled study of the influence of continuous subcutaneous insulin infusion treatment on diabetic retinopathy during pregnancy. Forty consecutive pregnant patients with insulin‐dependent (Type I) diabetes mellitus were randomized at the end of the first trimester for treatment with conventional insulin therapy (CIT) or continuous subcutaneous insulin infusion therapy (CSII). Nine patients randomized into the CSII group declined the pump treatment. The mean glycosylated haemoglobin (Hb A1c) decreased (p<0.001) both in the CIT and the CSII groups with no difference between the groups. Some deterioration in retinopathy was found in 2/18 patients in the CIT group, in 5/13 in the CSII group, and in 3/9 of those who declined the pump treatment. The proportion of patients whose retinopathy progressed did not differ significantly between the groups, and in the majority the deterioration was mild. However, two patients in the CSII group developed acute ischaemic retinopathy, which progressed to proliferative stage in spite of laser treatment. In these two cases the decrease in the Hb Alc level was among the greatest and fastest in the study. These data suggest that a rapid near normalization of glycaemic control by CSII during pregnancy can accelerate the progress of retinopathy in poorly controlled diabetic patients.

Progression of retinopathy during pregnancy in type 1 diabetes mellitus

“…Progression of retinopathy has been noted in those pregnancies where there was a rapid decrease in HbA 1c by some authors who have cautioned against achieving euglycaemia too rapidly. 3,6,7,26 Therefore, cautious normalization of serum glucose in patients with poor glycaemic control and retinopathy is advisable. 7,8,27,28 The Diabetes in Early Pregnancy Study found that duration of diabetes mellitus of more than 15 years in a patient was an important risk factor in the progression to severe retinopathy in pregnancy.…”

Progression of Retinopathy in Type 1 Diabetic Women During Pregnancy

“…Good glycaemic control is the cornerstone for both maternal and foetal wellbeing during pregnancy. Worsening of DR has been correlated with the degree of improvement of glycemic control obtained with the institution of intensive therapy performed before and during pregnancy [129,130,131,132].…”

“…Secondly, cotton wool spots (CWSs), areas of infarction of the nerve fibre layer of the retina, are associated with low fasting blood sugar [87] and rapidly achieved strict metabolic control [130,147]. These spots develop in some type I diabetic women with BDR during advancing pregnancy.…”

“…Duration of diabetes before conception is the prime risk factor as regards the presence, severity and progression of DR during pregnancy [83,85,87,101,145,[152][153][154][155]. Other crucial factors for the progression of DR during pregnancy are chronic and pregnancy-induced hypertension (PIH) [14,132,156], hyperglycaemia [129,130,132], poor glycemic control of diabetes at conception [131,132,154], and stage of DR at baseline [64,131,145,150,[155][156][157][158][159].…”

Progressive proliferative diabetic retinopathy after transplantation of the pancreas

“…However, by maintaining normoglycemia, regression of the proliferative retinopathy was achieved without laser therapy during the following months (Rosenlund et al 1988). Laatikainen et al (1987), Puklin et al (1982), Lawson et al (1982) and van Ballegooie et al (1984) reported on patients with an increasing proliferative change to retinal vessels in diabetic retinopathy despite optimal blood glucose control by the insulin pump. These patients showed no early stage of the retinopathy prior to insulin pump therapy.…”