No abstract

Thirty patients with insulin-dependent diabetes mellitus (IDDM) who had advanced background retinopathy were randomized to unchanged conventional treatment (UCT) or to continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 2 yr. The mean blood glucose and hemoglobin A1C (HbA1C) were significantly lower in the CSII group than in the UCT group. The mean blood glucose and HbA1C did not change from the first to the second year in either of the treatment groups in spite of less frequent home-monitoring of blood glucose and less frequent outpatient visits during the second year. Four patients in the CSII group and five in the UCT group developed proliferative retinopathy. However, a marginally significant trend was found toward more frequent improvement of retinal morphology in the CSII group (47%) than in the UCT group (13%). Beat-to-beat variation was found to deteriorate significantly with UCT compared with a nonsignificant improvement with CSII therapy. Vibration sense was unchanged in both treatment groups. It is concluded that near-normal blood glucose levels can be maintained with CSII therapy in spite of less frequent home-monitoring of blood glucose and outpatient visits. Furthermore, established background retinopathy may progress to proliferative retinopathy in spite of 2 yr of near-normal blood glucose levels. However, a marginally significant trend toward more frequent improvement of retinal morphology was found among CSII-treated patients compared with conventionally treated patients. Large-scale, prospective, randomized studies are needed to confirm these results.

The study draws a comparison between the oscillatory potential of the electroretinogram and the initial dark-adaptation measured by nyctometry, with the aim of assessing the predictive value of nyctometry in juvenile diabetics. The study included 61 insulin-dependent juvenile diabetics, aged 18-49 years, with a disease duration of more than five years. A statistically highly significant correlation could be demonstrated between alterations in the oscillatory potential and in the initial dark-adaptation. The results justify the assumption that nyctometry can be used as an easily handled clinical tool in selecting those at risk of developing proliferative retinopathy in their subsequent 6-8 years.

The effect of calcium dobesilate on capillary resistance and background retinopathy was compared with placebo in a double-blind cross-over trial on 18 diabetics. Each treatment lasted 8 months. The trial produced no evidence in favour of a significant beneficial effect of calcium dobesilate on the capillary resistance in diabetics or on the course of the diabetic retinopathy.