The response of diabetic retinopathy to 41 months of multiple insulin injections, insulin pumps, and conventional insulin therapy.
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.
D000328:Adult; D000783:Aneurysm / Q000473:pathology; D001786:Blood Glucose / Q000032:analysis; D002986:Clinical Trials as Topic; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000473:pathology; D005122:Exudates and Transudates / Q000378:metabolism; D005451:Fluorescein Angiography; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007267:Injections; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D012166:Retinal Hemorrhage / Q000473:pathology; D012171:Retinal Vessels / Q000378:metabolism; D013997:Time Factors
D001786:Blood Glucose; D007328:Insulin; D006441:Hemoglobin A