Long-term progression of retinopathy after initiation of insulin therapy in Type�2 diabetes: an observational study

Abstract

Aims/hypothesis. Universal worsening of retinopathy after starting insulin therapy in Type 2 diabetes has been suggested in previous work. Methods. We studied 294 such patients for up to 5 years to evaluate retinal changes and define the factors affecting progression of retinopathy. Yearly retinal photographs were graded using the EURODIAB system. Results. Prior to insulin therapy, 26.2% (77/294) of the patients had minimal non-proliferative diabetic retinopathy (NPDR), 3.7% (n=11) had moderate NPDR and 1% (n=3) had severe NPDR. Over the first 3 years of insulin therapy, significant progression occurred in 36 subjects (12.6%). This comprised 5/193 (2.6%) without any retinopathy at baseline, 22/77 (28.5%) with minimal NPDR and 6/11 with moderate NPDR (54.5%) (χ 2 =56.1, p<0.001). In a control group of 70 patients who remained on oral hypoglycaemic agents, nine patients had significant worsening of retinopathy over 3 years. Over 5 years, 22/127 (17.3%) of patients (9/95 without and 13/32 with retinopathy at baseline [χ 2 =16.2, p<0.001]) had significant progression of retinopathy. Higher baseline HbA 1 c (p=0.002) and lower initial decrease in HbA 1 c (p=0.007) were each independent predictors of greater retinopathy progression over this period. There was no significant worsening of visual acuity in patients whose retinopathy progressed. Conclusions/interpretation. After initiation of insulin treatment in Type 2 diabetes, clinically significant worsening of retinopathy over a 3-year period was uncommon in those with no retinopathy (2.6%) but occurred in 31.8% of patients with any retinopathy at baseline. The risk of serious worsening of retinopathy after insulin therapy is started in all patients with Type 2 diabetes may have been previously overestimated.

Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes

“…An established grading system (EURODIAB) was used to classify the retinal changes [15]. This system has been previously validated [16] and allowed classification of retinopathy into early non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, proliferative and laser-treated retinopathy based on the above grading Number of women Fig. 1 The number of women in whom laser therapy was required increased from one to five during pregnancy, with no further increase after delivery (black squares).…”

A food‐based, low‐energy, low‐carbohydrate diet for people with type 2 diabetes in primary care: A randomized controlled feasibility trial

“…HbA1c ≥93 mmol/mol (10.5%); or non-proliferative retinopathy level R2 or more severe, proliferative diabetic retinopathy or maculopathy (recognizing concerns that sudden normalization in retinal blood flow, associated with restoration of normoglycaemia, may result in deterioration of established retinopathy 9 ) (see the supporting information, Appendix S1). After telephone screening by researchers, eligible patients were booked for a baseline appointment with a nurse at their local practice, where nurses confirmed consent and verified inclusion.…”

Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults

“…Topical administration of either GLP1RA (33) or DPP4i (34) prevents retinal neurodegeneration in mice. Further, the rapid glycemic control when initiating LAI is associated with early worsening of DR (23,(35)(36)(37), which could contribute to this finding. TZD's effects on macular edema (24,38) may contribute to the observed GLP1RA's lower risk of IDR as well, although evidence has been conflicting (38,39).…”