Worsening of Diabetic Retinopathy After Improvement of Glycemic Control

Davis, Matthew D.

doi:10.1001/archopht.116.7.931

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…Cytokines and trophic factors including the mitogenic cytokine, vascular endothelial growth factor (VEGF), insulin growth factor (IGF), IL-6, IL-8 and TNF-α have been implicated in the pathogenesis of diabetic retinopathy. It is hypothesized that upregulation of these cytokines and trophic factors associated with intensive glycemic control is responsible for the early worsening of retinopathy 23-25…”

Section: Discussionmentioning

confidence: 99%

Treatment‐induced diabetic neuropathy: A reversible painful autonomic neuropathy

Gibbons

Freeman

2010

Annals of Neurology

187

151

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Objective-To describe the natural history, clinical, neurophysiological and histological features and outcomes of diabetic patients presenting with acute painful neuropathy associated with glycemic control, also referred to as 'insulin neuritis'.Methods-Sixteen subjects, presenting with acute painful neuropathy had neurological and retinal examinations, laboratory studies, autonomic testing and pain assessments over 18 months. Eight subjects had skin biopsies for evaluation of intra-epidermal nerve fiber density.Results-All subjects developed severe pain within 8 weeks of intensive glucose control. There was a high prevalence of autonomic cardiovascular, gastrointestinal, genitourinary, and sudomotor symptoms in all subjects. Orthostatic hypotension and parasympathetic dysfunction were seen in 69% of subjects. Retinopathy worsened in all subjects. Reduced intra-epidermal nerve fiber density (IENFD) was seen in all tested subjects. After 18 months of glycemic control, there were substantial improvements in pain, autonomic symptoms, autonomic test results and IENFD. Greater improvements were seen after 18 months in type 1 vs. type 2 diabetic subjects in autonomic symptoms (cardiovascular p<0.01; gastrointestinal p<0.01; genitourinary p<0.01) and autonomic function tests (p<0.01, sympathetic and parasympathetic function tests).Interpretation-Treatment induced neuropathy is characterized by acute, severe pain, peripheral nerve degeneration and autonomic dysfunction after intensive glycemic control. The neuropathy occurred in parallel with worsening diabetic retinopathy suggesting a common underlying pathophysiological mechanism. Clinical features and objective measures of small myelinated and unmyelinated nerve fibers can improve in these diabetic patients despite a prolonged history of poor glucose control, with greater improvement seen in patients with type 1 diabetes. Keywords diabetic neuropathy; painful neuropathy; autonomic neuropathyWhile chronic neuropathic pain occurs frequently in diabetic patients, acute severe neuropathic pain is rarely encountered. Several different acute painful syndromes occur: 1) Pain may appear shortly after the initiation of intensive glycemic control, sometimes referred to as 'insulin neuritis' or treatment induced neuropathy. 1-3 Characteristically, the painful neuropathy is preceded by rapid glycemic control. 2) Additional cases present in association with severe weight loss with or without a change in glycemic control, a disorder

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Section: Discussionmentioning

confidence: 99%

Treatment‐induced diabetic neuropathy: A reversible painful autonomic neuropathy

Gibbons

Freeman

2010

Annals of Neurology

187

151

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“…The rapid progression of retinopathy is consistent with prior reports of unanticipated worsening of retinopathy in individuals with type 1 and type 2 diabetes that occurred shortly after the initiation of intensive treatment with insulin. It is hypothesized that upregulation of these cytokines and trophic factors associated with intensive glycemic control is responsible for the early worsening of retinopathy (Chantelau, 1998;Davis, 1998;Klein et al, 2009). The cause of the early worsening of retinopathy is not known.…”

Section: Concomitant Featuresmentioning

confidence: 99%

Diabetic autonomic neuropathy

Freeman

2014

Handbook of Clinical Neurology

114

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“…Among the intensively treated patients in the DCCT trial, no early worsening of retinopathy was observed in the patients with no retinopathy at baseline. Moreover, the longterm bene®t of intensive insulin treatment was so great that the outcome was better in intensively treated patients who experienced early worsening than in conventionally treated patients who did not (Davis, 1998). An increase in IGF-I might thus result in a short-term deterioration in established complications before bene®ts are observed.…”

Section: Elevated Igf-i Levels and Diabetic Retinopathymentioning

confidence: 99%

Circulating Igf‐I And Its Protective Role In The Pathogenesis Of Diabetic Angiopathy

Janssen

Lamberts

2000

J Peripheral Nervous Sys

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Poor glycaemic control in type 1 diabetes is associated with elevated serum IGFBP‐1 levels and reduced rather than elevated serum IGF‐I levels. Increasing age is accompanied by a further decrease in serum IGF‐I levels as well as an increase in IGFBP‐1 levels in adult diabetic type 1 and type 2 subjects. This is especially observed in diabetic type 1 subjects with manifest microvascular complications. IGFBP‐1 has been proposed as one of the IGF‐I inhibitors in the serum of diabetics. Lowered IGF‐I and increased IGFBP‐1 levels in the blood may thus result in decreased IGF‐I bioavailability at the tissue level. We hypothesize that the premature and progressive decline in serum IGF‐I bioactivity during aging in diabetics ultimately results in insufficient protective effects by IGF‐I in the kidneys, eyes and neurones, and thus the progression of diabetic microvascular complications. If this hypothesis is proven to be right, treatment of diabetic patients with IGF‐I (eventually complexed to IGFBPs) as an adjunct to insulin might prevent and not worsen the development of diabetic microvascular complications.

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Worsening of Diabetic Retinopathy After Improvement of Glycemic Control

Cited by 12 publications

References 5 publications

Treatment‐induced diabetic neuropathy: A reversible painful autonomic neuropathy

Treatment‐induced diabetic neuropathy: A reversible painful autonomic neuropathy

Diabetic autonomic neuropathy

Circulating Igf‐I And Its Protective Role In The Pathogenesis Of Diabetic Angiopathy

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