title: Failure to initiate early insulin therapy - A risk factor for diabetic retinopathy in insulin users with Type 2 diabetes mellitus: Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS, Report number 35).
abstract: BACKGROUND
  Insulin users have been reported to have a higher incidence of diabetic retinopathy (DR).
  
  
  OBJECTIVE
  The aim was to elucidate the factors associated with DR among insulin users, especially association between duration, prior to initiating insulin for Type 2 diabetes mellitus (DM) and developing DR.
  
  
  METHODS
  Retrospective cross-sectional observational study included 1414 subjects having Type 2 DM. Insulin users were defined as subjects using insulin for glycemic control, and insulin nonusers as those either not using any antidiabetic treatment or using diet control or oral medications. The duration before initiating insulin after diagnosis was calculated by subtracting the duration of insulin usage from the duration of DM. DR was clinically graded using Klein's classification. SPSS (version 9.0) was used for statistical analysis.
  
  
  RESULTS
  Insulin users had more incidence of DR (52.9% vs. 16.3%, P < 0.0001) and sight threatening DR (19.1% vs. 2.4%, P < 0.0001) in comparison to insulin nonusers. Among insulin users, longer duration of DM (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.00-1.25, P = 0.044) and abdominal obesity (OR 1.15, 95% CI 1.02-1.29, P = 0.021) was associated with DR. The presence of DR was significantly associated with longer duration (≥5 years) prior to initiating insulin therapy, overall (38.0% vs. 62.0%, P = 0.013), and in subjects with suboptimal glycemic control (32.5% vs. 67.5%, P = 0.022).
  
  
  CONCLUSIONS
  The presence of DR is significantly associated with longer duration of diabetes (>5 years) and sub-optimal glycemic control (glycosylated hemoglobin <7.0%). Among insulin users, abdominal obesity was found to be a significant predictor of DR; DR is associated with longer duration prior to initiating insulin therapy in Type 2 DM subjects with suboptimal glycemic control.
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India.
authors.forename: Kushal S
authors.initials: KS
authors.lastname: Delhiwala
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India.
authors.forename: Rajiv P G
authors.initials: RP
authors.lastname: Raman
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Sharma
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: Department of Preventive Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Vaitheeswaran
authors.initials: V
authors.lastname: Kulothungan
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D015994:Incidence; D007194:India / Q000453:epidemiology; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin