Reversion of ‘Early Worsening’ of Diabetic Retinopathy by Deliberate Restoration of Poor Metabolic Control

Abstract

Acutely lowering long-standing severe hyperglycaemia can trigger progression (‘early worsening’) of diabetic retinopathy, most likely by up-regulation of the circulating insulin-like growth factor 1 (IGF-1). This condition, also called ‘florid retinopathy’, rarely responds to standard laser coagulation treatment. In this retrospective report, 2 young patients with type 2 diabetes are described, in whom deliberate restoration of poor diabetes control reduced the serum IGF-1 levels and improved ‘early worsened’ diabetic retinopathy.

High Glucose Blunts Vascular Endothelial Growth Factor Response to Hypoxia via the Oxidative Stress-Regulated Hypoxia-Inducible Factor/Hypoxia-Responsible Element Pathway

“…This may help to explain the clinical observation that diabetic retinopathy may worsen soon after intensive glycemic control, which would increase local VEGF levels in the eye (27,28). Deliberate restoration of poor glycemic control has been reported to improve this early worsening of diabetic retinopathy (29).…”

Progression of diabetic retinopathy during improved metabolic control may be treated with reduced insulin dosage and/or somatostatin analogue administration – a case report

“…Downregulation of serum IGF-I levels in diabetic patients can be achieved by (partial) withdrawal of the adequate antidiabetic medication, e.g. by reduction of insulin dosage [6], or by drugs like octreotide [7][8][9].…”

Downregulation of Serum IGF-1 for Treatment of Early Worsening of Diabetic Retinopathy: A Long-Term Follow-Up of Two Cases

“…In 2001, incipient nephropathy was present, with microalbuminuria of 73 mg/l (normal <20 mg/l). However, albuminuria increased to 658 mg/l in 2002, and blood pressure also increased, requiring antihypertensive medication, while serum creatinine remained normal (<0.9 mg/dl) [4]. …”

“…In 2001, incipient nephropathy had been present with microalbuminuria of 50 mg/l; albuminuria improved to 14 mg/l in 2002. However, peripheral polyneuropathy progressed and acute Charcot foot occurred [4]. …”

“…Reversion of this acute retinal pathology may, thus, be achieved by re-lowering serum IGF-1 [3,4]. In 2003, a preliminary proof of this concept was provided by 2 patients with type 2 diabetes mellitus who had experienced EW and who were subsequently advised to discontinue intensive insulin therapy [4].…”