Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study.

Dahl‐Jørgensen, Knut; Brinchmann‐Hansen, Olaf; Hanssen, Kristian F.; Sandvik, Leiv; Aagenaes, Ø

doi:10.1136/bmj.290.6471.811

Cited by 336 publications

(163 citation statements)

References 16 publications

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“…Moreover, our study demonstrates that insulin therapy is independent of the BglII gene polymorphism, which is statistically significantly associated with diabetic retinopathy. This finding suggests the existence of other factors, such as differences in the ability of insulin secretion, or differences in the frequency of episodes of hypoglycemia, or adverse events associated with insulin therapy (hypoglycemia, worsening diabetic retinopathy if HbA 1c decreases rapidly; DeWitt and Hirsch 2003;Dahl-Jorgensen et al 1985).…”

Section: Discussionmentioning

confidence: 92%

BglII gene polymorphism of the α2β1 integrin gene is a risk factor for diabetic retinopathy in Caucasians with type 2 diabetes

et al. 2003

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Platelets are thought to be involved in the pathogenesis of diabetic retinopathy. The BglII gene polymorphism of the a2b1 integrin, which is a platelet collagen receptor, has been suggested as a genetic risk factor for diabetic retinopathy in Japanese subjects. The aim of this study was to look for a relationship between the BglII gene polymorphism of the a2b1 integrin gene and the development of diabetic retinopathy in Caucasians with type 2 diabetes. Subjects with type 2 diabetes and diabetic retinopathy (n=163) were compared with diabetic subjects without diabetic retinopathy (n=95). A significantly higher frequency of the BglII (+/+) genotype of the gene polymorphism of the a2b1 integrin gene was found in patients with diabetic retinopathy compared with patients without diabetic retinopathy (19.6% vs 7.4%; P=0.008). The present study demonstrates that the BglII (+/+) genotype of the gene polymorphism of the a2b1 integrin gene is an independent risk factor (odds ratio: 2.4, 95% confidence interval 1.0-6.0; P<0.05) for diabetic retinopathy in Caucasians with type 2 diabetes.Keywords BglII gene polymorphism of the a2b1 integrin AE Diabetic retinopathy AE Type 2 diabetes AE Association study AE Genetic risk factor Introduction Diabetic retinopathy, a leading cause of blindness in the working population, is a microvascular complication of diabetes (Klein and Klein 1995). Several epidemiological and experimental studies indicate that the duration of diabetes and glycemic control are major determinants for the development of diabetic retinopathy, whereas previously identified nongenetic risk factors are variable and include HbA 1C , age at diagnosis, blood pressure, plasma cholesterol, proteinuria, fasting glycemia, body mass index (BMI), waist-to-hip ratio, and insulin treatment (Engerma and Kern 1987;Porta et al. 2001;Keen et al. 2001). Diabetic retinopathy is characterized by increased vascular permeability, hemostatic abnormalities, increased tissue ischemia, and neoangiogenesis (Winocour 1992). Platelets are thought to be involved in the pathogenesis of diabetic retinopathy (Barnett 1991). Platelets from diabetic patients are hyper-reactive to aggregating agents, such as collagen, thrombin, and adenosine diphosphate (Winocour 1992). The platelet membrane glycoprotein Ia/IIa, a2b1 integrin, serves as a platelet receptor for collagen (Santoro and Zutter 2001;Moroi and Jung 1997). Recently, genetic variations in a2b1 integrin have been shown to affect the density of a2b1 receptors on the platelet surface (Kritzik et al. 1998;Kunicki et al. 1997). Moreover, Matsubara et al. (2000) have demonstrated the association between genetic variations in a2b1 integrin and diabetic retinopathy in the Japanese population. The aim of this study has been to determine whether the BglII gene polymorphism of the a2b1 integrin gene is a risk factor for the development of diabetic retinopathy in Caucasians with type 2 diabetes. Patients and methodsIn this cross-sectional case-control study, 258 unrelated Caucasian subjects...

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Section: Discussionmentioning

confidence: 92%

BglII gene polymorphism of the α2β1 integrin gene is a risk factor for diabetic retinopathy in Caucasians with type 2 diabetes

et al. 2003

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“…The study periods lasted from a minimum of 5 weeks to a maximum of 2 years. Upon our request, the authors of the Oslo Study [17,18,23,[25][26][27][28][29] told us that the study was originally intended to last for 2 years, but was later extended to 4 years. Due to incomplete data records after 4 years, only the results from the 2 year analysis were considered for this review.…”

Section: Description Of Included Trialsmentioning

confidence: 99%

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

et al. 2008

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Aims We compared the effects of continuous subcutaneous insulin infusion (CSII) with those of multiple daily insulin (MDI) injections on glycaemic control, risk of hypoglycaemic episodes, insulin requirements and adverse events in type 1 and type 2 diabetes mellitus. Methods The electronic databases MEDLINE, EMBASE and CENTRAL were systematically searched for randomised controlled trials up to March 2007. A systematic review and meta-analysis were performed. Results Overall, 22 studies were included (17 on type 1 diabetes mellitus, two on type 2 diabetes mellitus, three on children). With regard to adults with type 1 diabetes mellitus, our meta-analysis found a between-treatment difference of −0.4% HbA 1c (six studies) in favour of CSII therapy. Available median rates of mild or overall hypoglycaemic events were comparable between the different interventions (1.9 [0.9-3.1] [CSII] vs 1.7 [1. 1-3.3] [MDI] events per patient per week). Total daily insulin requirements were lower with CSII than with MDI therapy. In patients with type 2 diabetes mellitus, CSII and MDI treatment showed no statistically significant difference for HbA 1c . The incidence of mild hypoglycaemic events was comparable between the treatment groups. In adolescents with type 1 diabetes mellitus, glycated haemoglobin and insulin requirements were significantly lower in the CSII groups; no data were available on hypoglycaemic events. The only study performed in younger children did not provide enough data for conclusive inferences. No overall conclusions were possible for severe hypoglycaemia and adverse events for any of the different patient groups due to rareness of such events, different definitions and insufficient reporting. Conclusions/interpretation CSII therapy in adults and adolescents with type 1 diabetes mellitus resulted in a greater reduction of glycated haemoglobin, in adult patients without a higher rate of hypoglycaemia. No beneficial effect of CSII therapy could be detected for patients with type 2 diabetes mellitus. Diabetologia (2008) 51:941-951

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“…The role of hyperglycaemia in the development and progression of microangiopathy is controversial [25]. Previous prospective studies, which relied on less satisfactory indices of glycaemic control than HbA1 [1,26,27], have suggested a link between the onset of retinopathy and poor control, whereas improving glycaemic control in established retinopathy has shown no convincing modification of progression [21,[28][29][30]. In our study the development of retinopathy was accompanied by a rise in diastolic blood pressure, especially in males, but multiple regression analysis showed that raised diastolic blood pressure was more closely associated with raised urinary albumin concentration than with retinopathy.…”

Section: Discussionmentioning

confidence: 99%

Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications)

Young

MacIntyre

Martyn³

et al. 1986

Diabetologia

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Summary. The progression of subclinical polyneuropathy over 2.5 years has been studied in a representative group of 75 young patients with Type I (insulin-dependent) diabetes (initial age 16-19years). The relationships between changes in nerve function, glycaemic control and concurrently developing microvascular complications (retinopathy, microproteinuria) were investigated. Deterioration of motor, sensory and autonomic nerve function, retinopathy and microproteinuria was related to poor glycaemic control. In addition, there was an association between developing neural and microvascular complications which was not diminished when their common relationship to hyperglycaemia was taken into account. These findings suggest that, although poor glycaemic control is an essential permissive factor in the early development of diabetic polyneuropathy, other influences, shared with microvascular complications, must also be important.

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Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study.

Cited by 336 publications

References 16 publications

BglII gene polymorphism of the α2β1 integrin gene is a risk factor for diabetic retinopathy in Caucasians with type 2 diabetes

BglII gene polymorphism of the α2β1 integrin gene is a risk factor for diabetic retinopathy in Caucasians with type 2 diabetes

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications)

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