Bilateral diabetic papillopathy and metabolic control.
OBJECTIVE
The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis.


METHODS
Retrospective case-control study.


METHODS
Two thousand sixty-six patients with type 1 diabetes.


METHODS
Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008.


METHODS
Simultaneous, bilateral diabetic papillopathy.


RESULTS
The mean follow-up was 4.9 years. During 10,020 patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A₁(c) (HbA₁(C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly different from the changes in HbA₁(C) observed in the remainder of the study population (P<0.001). Photographs recorded before the onset of bilateral diabetic papillopathy showed that all 5 patients had small cup-to-disc diameter ratios in both eyes (P<0.001).


CONCLUSIONS
Diabetic papillopathy was associated markedly with a drastic recent reduction in glycemia and a small cup-to-disc diameter ratio. This supports the hypothesis that diabetic papillopathy may be an early worsening phenomenon occurring in anatomically predisposed patients in response to a recent rapid decrease in glycemia.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ostri
Christoffer
C
Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark. oejenforsk@glo.regionh.dk
Lund-Andersen
Henrik
H
Sander
Birgit
B
Hvidt-Nielsen
Ditte
D
Larsen
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000209:etiology; D003929:Diabetic Neuropathies / Q000097:blood* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D010211:Papilledema / Q000097:blood* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human