The response of diabetic retinopathy to 41 months of multiple insulin injections, insulin pumps, and conventional insulin therapy

O. Brinchmann-Hansen, K. Dahl-Jorgensen, K. F. Hanssen and L. Sandvik
Department of Ophthalmology, Ulleval University Hospital, Oslo, Norway.

Forty-five diabetic patients were randomized and treated with continuous subcutaneous insulin infusion (CSII), multiple insulin injections (MI), or conventional insulin treatment (CIT) for 41 months. Near-normoglycemia was obtained with CSII and MI but not with CIT. A transient increase in microaneurysms and hemorrhages was seen at three months in CSII-treated patients. After 41 months, a moderate progression in microaneurysms and hemorrhages was registered, as assessed from fundus photographs, in all treatment groups. Fluorescein angiograms indicated a tendency (not statistically significant) to retarded progression of retinopathy in MI- and CSII-treated patients compared with CIT-treated patients. Soft exudates developed after three to six months of rapid tightening of metabolic control in 50% of patients on CSII and MI regimens. Those patients who had soft exudates had a slower progression of retinopathy three years later than those who did not develop soft exudates. Transient progression of retinopathy may be related to fluctuations in blood glucose levels, although a favorable effect of long-term improved metabolic control was not documented.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Risk of Developing Retinopathy in Diabetes Control and Complications Trial Type 1 Diabetic Patients With Good or Poor Metabolic Control
Zhang et al.
Diabetes Care 2001;24:1275-1279.
ABSTRACT | FULL TEXT  

Interpretation of Hemoglobin A1c (HbA1c) Values among Diabetic Patients: Implications for Quality Specifications for HbA1c
Skeie et al.
Clin. Chem. 2001;47:1212-1217.
ABSTRACT | FULL TEXT  

Early Worsening of Diabetic Retinopathy in the Diabetes Control and Complications Trial
The Diabetes Control and Complications Trial Resea
Arch Ophthalmol 1998;116:874-886.
ABSTRACT | FULL TEXT  

The Effect of Glycemic Control on the Incidence of Macrovascular Complications of Type 2 Diabetes
Stern
Arch Fam Med 1998;7:155-162.
ABSTRACT | FULL TEXT  

Diseases of the Retina
D'Amico
NEJM 1994;331:95-106.
FULL TEXT  

The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus
The Diabetes Control and Complications Trial Resea
NEJM 1993;329:977-986.
ABSTRACT | FULL TEXT  

The Effect of Long-Term Intensified Insulin Treatment on the Development of Microvascular Complications of Diabetes Mellitus
Reichard et al.
NEJM 1993;329:304-309.
ABSTRACT | FULL TEXT  

Long-Term Complications of Diabetes Mellitus
Nathan
NEJM 1993;328:1676-1685.
FULL TEXT