Effect of Insulin Infusion Pump Use on Diabetic Retinopathy

Kelly, Thomas M.; Sanborn, George E.; Haug, Peter J.; Edwards, Corwin Q.

doi:10.1001/archopht.1984.01040030934017

Cited by 19 publications

(4 citation statements)

References 17 publications

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“…Our observations provide experimental evidence that the progression of retinopathy tends to resist arrest and suggest that the design of clinical trials should take this possibility into consideration. Attempts in patients to arrest diabetic retinopathy by improving glycemic control have yielded controversial results and some alarming evidence that the retinopathy may worsen initially rather than improve when glycemic control is tightened (9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 44%

Progression of Incipient Diabetic Retinopathy During Good Glycemic Control

1987

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To assess the extent to which the progression of diabetic retinopathy can be arrested by improved glycemic control, 35 normal dogs were randomly divided into a nondiabetic and three alloxan-induced diabetic groups prospectively identified according to glycemic control: poor control for 5 yr (PC), good control for 5 yr (GC), and poor control for 2.5 yr followed by good control for 2.5 yr (PGC). To achieve good control, insulin was given twice daily together with a measured diet so that hyperglycemia and glucosuria were mild and infrequent, and HbA1 was comparable to normal. Retinal capillary aneurysms and other lesions developed during 60 mo of poor control (group PC) and were inhibited if good control was begun promptly within 2 mo (group GC). In group PGC, retinopathy was absent or equivocal at 2.5 yr of poor control and, surprisingly, was found to develop subsequently despite good glycemic control. Retinopathy in group PGC was greater at autopsy than at 2.5 yr and was greater than in group GC. The results indicate that retinopathy may be preventable but tends to resist arrest even in its incipient stages, before more than the first few aneurysms have appeared.

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Section: Discussionmentioning

confidence: 44%

Progression of Incipient Diabetic Retinopathy During Good Glycemic Control

1987

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“…Early studies assessing diabetic retinopathy progression following the introduction of CSII typically showed no improvement or deterioration of diabetic retinopathy with CSII [ 7 , 8 ]. However, study numbers were small, participants were selected for CSII due to poor glycaemic control on conventional therapy and suitable comparator groups were not used.…”

Section: Introductionmentioning

confidence: 99%

Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin

et al. 2021

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Aims/hypothesis We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI). Methods This is a retrospective cohort study using the Scottish Care Information – Diabetes database for retinal screening outcomes and HbA1c changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan–Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA1c, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA1c and change in HbA1c on diabetic retinopathy progression was assessed within CSII and MDI cohorts. Results CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA1c and higher diastolic BP at baseline. There was a larger reduction in HbA1c at 1 year in those on CSII vs MDI (−6 mmol/mol [−0.6%] vs −2 mmol/mol [−0.2%], p < 0.01). Diabetic retinopathy progression occurred in a smaller proportion of adults following commencement of CSII vs continued MDI therapy over mean 2.3 year follow-up (26.5% vs 18.6%, p = 0.0097). High baseline HbA1c (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA1c at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. Conclusions/interpretation CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA1c. Progression of diabetic retinopathy over 3 years was not associated with a change in HbA1c. Graphical abstract

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“…Harrad et al (1984), however, found that even a slow improvement in diabetic control leads to an initial deterioration in retinal morphology. Kelly et al (1984) observed that diabetic retinopathy developed during CSII treatment in a patient who had no prior diabetic retinal changes, i.e. CSII did not prevent the development of diabetic retinopathy.…”

Section: Proliferative Retinopathy Despite Normoglycemiamentioning

confidence: 92%

Progressive proliferative diabetic retinopathy after transplantation of the pancreas

Schmidt

Kirste

Schrader

1994

Acta Ophthalmologica

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The unusual case history of the development of a progressive diabetic retinopathy despite normal blood glucose after transplantation of the pancreas and despite panretinal laser coagulations is described. A 26-year-old male with diabetic background retinopathy underwent a segmental transplantation of the pancreas in 1988. One year after surgery, a progressive proliferative retinopathy despite normoglycemia was found, which required an intensive panretinal photocoagulation during the following months. However, despite massive retinal coagulations, vitreous hemorrhages and retinal neovascularizations continuously occurred, thus requiring two vitrectomies. After these procedures, visual acuity recovered distinctly. It is suggested that the 'point of no return' for the development of proliferative changes in the retina had been passed at a time when a background retinopathy was still present. The effect of normoglycemia during follow-up of patients with diabetic retinopathy, described in the literature, is compared to this unusual case history.

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Effect of Insulin Infusion Pump Use on Diabetic Retinopathy

Cited by 19 publications

References 17 publications

Progression of Incipient Diabetic Retinopathy During Good Glycemic Control

Progression of Incipient Diabetic Retinopathy During Good Glycemic Control

Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin

Progressive proliferative diabetic retinopathy after transplantation of the pancreas

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