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The Response of Diabetic Retinopathy to 41 Months of Multiple Insulin Injections, Insulin Pumps, and Conventional Insulin Therapy

The Response of Diabetic Retinopathy to 41 Months of Multiple Insulin Injections, Insulin Pumps,... Abstract • 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. References 1. Lauritzen T, Frost-Larsen K, Larsen H-W, et al: Effect of one year of near-normal blood glucose levels on retinopathy in insulin-dependent diabetics . Lancet 1983;1:200-204.Crossref 2. The Kroc Collaborative Study Group: Blood glucose control and the evolution of diabetic retinopathy and albuminuria . N Engl J Med 1984;311:365-372.Crossref 3. Van Ballegooie E, Hooymans JMM, Timmerman Z, et al: Rapid deterioration of diabetic retinopathy during treatment with continuous subcutaneous insulin infusion . Diabetes Care 1984;7:236-242.Crossref 4. Brinchmann-Hansen O, Dahl-Jørgensen K, Hanssen KF, et al: Effects of intensified insulin treatment on various lesions of diabetic retinopathy . Am J Ophthalmol 1985;100:644-653. 5. Dahl-Jørgensen K, Brinchmann-Hansen O, Hanssen KF, et al: Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: The Oslo study . Br Med J Clin Res 1985;290:811-815.Crossref 6. Dahl-Jørgensen K, Brinchmann-Hansen O, Hanssen KF, et al: Effect of near normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy, and neuropathy: The Oslo study . Br Med J Clin Res 1986;293:1195-1199.Crossref 7. Dahl-Jørgensen K, Larsen AE: HbA1 determination by agar gel electrophoresis after elimination of labile HbA1: A comparison with ion-exchange chromatography . Scand J Clin Lab Invest 1982;42:27-33.Crossref 8. Tamborlane WV, Puklin JE, Bergman M, et al: Long-term improvement of metabolic control with the insulin pump does not reverse diabetic microangiopathy . Diabetes Care 1982;5( (suppl 1) ):58-64. 9. Lauritzen T, Frost-Larsen K, Larsen H-W, et al: Two years' experience with continuous subcutaneous insulin infusion in relation to retinopathy and neuropathy . Diabetes 1985;34( (suppl 3) ):74-79.Crossref 10. The Kroc Collaborative Study Group: The Kroc Study patients at two years: A report on further retinal changes , abstracted. Diabetes 1985;34( (suppl) ):39A.Crossref 11. Job D, Eschwege E, Guyot-Argenton C, et al: Effect of multiple daily insulin injections on the course of diabetic retinopathy . Diabetes 1976;25:463-469.Crossref 12. Friberg TR, Rosenstock J, Sanborn G, et al: The effect of long-term near normal glycemic control on mild diabetic retinopathy . Ophthalmology 1985;92:1051-1058.Crossref 13. Canny CLB, Kohner EM, Trautman J, et al for The Kroc Collaborative Study Group: Comparision of Stereofundus photographs in patients with insulin-dependent diabetes during conventional insulin treatment or continuous subcutaneous insulin infusion . Diabetes 1985;34( (suppl 3) ):50-55.Crossref 14. Hanssen KF, Dahl-Jørgensen K, Lauritzen T, et al: Diabetic control and microvascular complications: The near-normoglycaemic experience . Diabetologia 1986;29:677-684.Crossref 15. Dornan T, Mann JI, Turner R: Factors protective against retinopathy in insulin-dependent diabetics free of retinopathy for 30 years . Br Med J Clin Res 1982;285:1073-1077.Crossref 16. Klein R, Klein BEK, Moss SE, et al: The Wisconsin epidemiologic study of diabetic retinopathy: II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol 1984;102:520-532.Crossref 17. Knuiman MW, Welborn TA, McCann VJ, et al: Prevalence of diabetic complications in relation to risk factors . Diabetes 1986;35:1332-1339.Crossref 18. Kohner EM, Dollery CT: The rate of formation and disappearance of microaneurysms in diabetic retinopathy . Eur J Clin Invest 1970;1:167-171.Crossref 19. Kohner EM, Sleightholm M: The Kroc Collaborative Study Group: Does microaneurysm count reflect severity of early diabetic retinopathy? Ophthalmology 1986;93:586-589.Crossref 20. Kohner EM, Dollery CT, Bulpitt CJ: Cotton-wool spots in diabetic retinopathy . Diabetes 1969;18:691-704. 21. Roy MS, Rick ME, Higgings KE, et al: Retinal cotton-wool spots: An early finding in diabetic retinopathy? Br J Ophthalmol 1986;70:772-778.Crossref 22. Esmann V, Lundbæk K, Madsen PH: Types of exudates in diabetic retinopathy . Acta Med Scand 1963;174:375-384.Crossref 23. The DCCT Research Group: Diabetes Control and Complications Trial (DCCT): Results of feasibility study . Diabetes Care 1987;10:1-19.Crossref 24. Brinchmann-Hansen O, Dahl-Jørgensen K, Hanssen KF, et al: Effects of intensified insulin treatment on retinal vessels in diabetic patients . Br J Ophthalmol , 1988;72:666-673.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

The Response of Diabetic Retinopathy to 41 Months of Multiple Insulin Injections, Insulin Pumps, and Conventional Insulin Therapy

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1988.01060140402041
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Abstract

Abstract • 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. References 1. Lauritzen T, Frost-Larsen K, Larsen H-W, et al: Effect of one year of near-normal blood glucose levels on retinopathy in insulin-dependent diabetics . Lancet 1983;1:200-204.Crossref 2. The Kroc Collaborative Study Group: Blood glucose control and the evolution of diabetic retinopathy and albuminuria . N Engl J Med 1984;311:365-372.Crossref 3. Van Ballegooie E, Hooymans JMM, Timmerman Z, et al: Rapid deterioration of diabetic retinopathy during treatment with continuous subcutaneous insulin infusion . Diabetes Care 1984;7:236-242.Crossref 4. Brinchmann-Hansen O, Dahl-Jørgensen K, Hanssen KF, et al: Effects of intensified insulin treatment on various lesions of diabetic retinopathy . Am J Ophthalmol 1985;100:644-653. 5. Dahl-Jørgensen K, Brinchmann-Hansen O, Hanssen KF, et al: Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: The Oslo study . Br Med J Clin Res 1985;290:811-815.Crossref 6. Dahl-Jørgensen K, Brinchmann-Hansen O, Hanssen KF, et al: Effect of near normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy, and neuropathy: The Oslo study . Br Med J Clin Res 1986;293:1195-1199.Crossref 7. Dahl-Jørgensen K, Larsen AE: HbA1 determination by agar gel electrophoresis after elimination of labile HbA1: A comparison with ion-exchange chromatography . Scand J Clin Lab Invest 1982;42:27-33.Crossref 8. Tamborlane WV, Puklin JE, Bergman M, et al: Long-term improvement of metabolic control with the insulin pump does not reverse diabetic microangiopathy . Diabetes Care 1982;5( (suppl 1) ):58-64. 9. Lauritzen T, Frost-Larsen K, Larsen H-W, et al: Two years' experience with continuous subcutaneous insulin infusion in relation to retinopathy and neuropathy . Diabetes 1985;34( (suppl 3) ):74-79.Crossref 10. The Kroc Collaborative Study Group: The Kroc Study patients at two years: A report on further retinal changes , abstracted. Diabetes 1985;34( (suppl) ):39A.Crossref 11. Job D, Eschwege E, Guyot-Argenton C, et al: Effect of multiple daily insulin injections on the course of diabetic retinopathy . Diabetes 1976;25:463-469.Crossref 12. Friberg TR, Rosenstock J, Sanborn G, et al: The effect of long-term near normal glycemic control on mild diabetic retinopathy . Ophthalmology 1985;92:1051-1058.Crossref 13. Canny CLB, Kohner EM, Trautman J, et al for The Kroc Collaborative Study Group: Comparision of Stereofundus photographs in patients with insulin-dependent diabetes during conventional insulin treatment or continuous subcutaneous insulin infusion . Diabetes 1985;34( (suppl 3) ):50-55.Crossref 14. Hanssen KF, Dahl-Jørgensen K, Lauritzen T, et al: Diabetic control and microvascular complications: The near-normoglycaemic experience . Diabetologia 1986;29:677-684.Crossref 15. Dornan T, Mann JI, Turner R: Factors protective against retinopathy in insulin-dependent diabetics free of retinopathy for 30 years . Br Med J Clin Res 1982;285:1073-1077.Crossref 16. Klein R, Klein BEK, Moss SE, et al: The Wisconsin epidemiologic study of diabetic retinopathy: II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol 1984;102:520-532.Crossref 17. Knuiman MW, Welborn TA, McCann VJ, et al: Prevalence of diabetic complications in relation to risk factors . Diabetes 1986;35:1332-1339.Crossref 18. Kohner EM, Dollery CT: The rate of formation and disappearance of microaneurysms in diabetic retinopathy . Eur J Clin Invest 1970;1:167-171.Crossref 19. Kohner EM, Sleightholm M: The Kroc Collaborative Study Group: Does microaneurysm count reflect severity of early diabetic retinopathy? Ophthalmology 1986;93:586-589.Crossref 20. Kohner EM, Dollery CT, Bulpitt CJ: Cotton-wool spots in diabetic retinopathy . Diabetes 1969;18:691-704. 21. Roy MS, Rick ME, Higgings KE, et al: Retinal cotton-wool spots: An early finding in diabetic retinopathy? Br J Ophthalmol 1986;70:772-778.Crossref 22. Esmann V, Lundbæk K, Madsen PH: Types of exudates in diabetic retinopathy . Acta Med Scand 1963;174:375-384.Crossref 23. The DCCT Research Group: Diabetes Control and Complications Trial (DCCT): Results of feasibility study . Diabetes Care 1987;10:1-19.Crossref 24. Brinchmann-Hansen O, Dahl-Jørgensen K, Hanssen KF, et al: Effects of intensified insulin treatment on retinal vessels in diabetic patients . Br J Ophthalmol , 1988;72:666-673.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Sep 1, 1988

References