title: Impact of insulin treatment in diabetic macular edema therapy in type 2 diabetes.
abstract: OBJECTIVE
  To evaluate the impact of insulin therapy on the outcomes of diabetic macular edema (DME) treatment with vascular endothelial growth factor (VEGF) inhibitors in people with type 2 diabetes.
  
  
  METHODS
  A retrospective consecutive case series of 95 patients with type 2 diabetes and DME who were treated with anti-VEGF therapy. We examined 2 cohorts: patients taking only oral antidiabetic agents and patients on insulin therapy. The main outcome measures were change in visual acuity and change in central subfield macular thickness measured by spectral-domain optical coherence tomography. The additional variables analyzed included glycated hemoglobin (A1C), creatinine, blood pressure and body mass index and their correlations with clinical findings.
  
  
  RESULTS
  Both groups had a statistically significant improvement in visual acuity (oral antidiabetic agents group: 20/61 to 20/49, p=0.003; insulin therapy group: 20/76 to 20/56, p=0.005). There was no difference between groups at initial or 12-month examination (p=0.239 and p=0.489, respectively). From an anatomic standpoint, central subfield macular thickness also improved significantly in both groups: from 454.7 μm to 354.9 μm (p<0.001) in the oral antidiabetic agents group and from 471.5 μm to 368.4 μm (p<0.001) in the insulin therapy group. Again, there was no significant difference between groups at initial or 12-month follow-up examinations (p=0.586 and p=0.591, respectively). Mean A1C levels remained relatively stable during the follow up in both groups.
  
  
  CONCLUSIONS
  Anti-VEGF therapy is a useful treatment for DME. This study suggests that chronic insulin therapy, compared with oral antidiabetic agents, does not modify the anatomic or functional effectiveness of DME treatment.
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America; Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Simone
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Tam
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America.
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Petkovsek
authors.affiliation: Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Zanella
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America. Electronic address: ehlersj@ccf.org.
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008269:Macular Edema / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D000069579:Ranibizumab; D012189:Retrospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D006442:Glycated Hemoglobin; D007328:Insulin; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A
keywords: Avastin(MC); Avastin™; VEGF-inhibitors; aflibercept; bevacizumab; bévacizumab; diabetic macular edema; diabetic retinopathy; glycated hemoglobin (A1C); hémoglobine glyquée (A1c); inhibiteurs du FCEV; insulin therapy; insulinothérapie; metabolic parameters; paramètres métaboliques; ranibizumab; rétinopathie diabétique; œdème maculaire diabétique