Progression of retinopathy after change of treatment from oral antihyperglycemic agents to insulin in patients with NIDDM.
OBJECTIVE
In insulin-dependent diabetes mellitus, institution of good glycemic control has been shown to retard development of retinopathy even though temporary progression has occurred. Few data have been available from patients with non-insulin-dependent diabetes mellitus (NIDDM). To determine the impact of improved glycemic control on retinopathy in patients with NIDDM, we examined, in a case-control study, the progression of retinopathy in 94 patients who changed treatment from oral antihyperglycemic agents to insulin.


METHODS
We used the Wisconsin retinopathy scale and related progression of retinopathy during a 2-year observation period to changes in HbA1c after institution of insulin therapy.


RESULTS
Progression of retinopathy > or = 3 levels occurred in 23% of the patients and was significantly more common in the patient group in which HbA1c was lowered > or = 3% compared with progression in the group in which HbA1c was lowered < 3% (P = 0.0001; relative risk 3.2; 95% confidence interval 1.5-6.9).


CONCLUSIONS
Improved glycemic control as achieved by insulin therapy may be associated with worsening of retinopathy in patients with NIDDM.
Henricsson
M
M
Department of Ophthalmology, Helsingborg Hospital, Sweden.
Janzon
L
L
Groop
L
L
D017668:Age of Onset; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use*; D008268:Macular Degeneration / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*; D013997:Time Factors; D014792:Visual Acuity
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds