EASDEC European Association for the Study of Diabetic Eye Complications
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EASDEC European Association for the Study of Diabetic Eye Complications |
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Abstracts: HenricssonHenricsson Marianne1, Berntorp Kerstin2, Berntorp Erik3, Fernlund Per4, Sundkvist Göran2, Progression of retinopathy after change of treatment from oral antihyperglycaemic agents to insulin in patients with Type 2 diabetes.Departments of Ophthalmology1 , Endocrinology2, Coagulation Disorders3 and Clinical Chemistry4 University Hospital, Malmö, Sweden. Objective:To determine the impact of improved glycaemic control on retinopathy in patients with Type 2 diabetes, we examined in a follow-up study, the progression of retinopathy in 45 patients who changed treatment from oral antihyperglycaemic agents to insulin. Progression of retinopathy was compared with that in a control group of 45 patients on oral treatment. Methods:The patients were examined at baseline and after 1,3,6,12, and 24 months. Retinopathy was graded on fundus photographs using the Wisconsin scale. Examinations included HbA1c, IGF-1 and haemostatic factors such as fibrinogen, PAI-1, APC, Factor VII, Factor F 1+2, VWF. Results:Forty-three surviving patients were followed for 2 years. Twenty-three of them progressed in the retinopathy scale and 20 were unchanged or improved. Eight patients (19 %) progressed ³ 3 levels. Progression was similar in the patient and control group. HbA1c and IGF-1 were significantly lowered during follow-up, whereas the haemostatic parameters did not change significantly. Progression of retinopathy was related to a greater HbA1c reduction; The relative risk for progression ³ 3 levels was 2.6 when HbA1c had been reduced ³ 3 percent units (95% confidence interval 1.1-6.1). IGF-1 did not differ between groups, whereas F 1+2 was significantly higher in those who progressed ³ 3 levels, In a logistic regression analysis, progression of retinopathy ³ 3 levels was significantly associated with a longer duration of diabetes (p=0.05), a higher HbA1c at entry (borderline significans, p = 0.06) and a lower HbA1c during the study period (p = 0.04). Conclusion:Improved glycaemic control as achieved by insulin therapy may be associated with progression of retinopathy in patients with Type 2 diabetes. Retinopathy progression was not associated with level of IGF-1 or haemostatic variables except for a raised F 1+2. |
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