Early Worsening of Diabetic Retinopathy in the Diabetes Control and Complications Trial
Abstract
Objectives To document the frequency, importance of, and risk factors for "early worsening" of diabetic retinopathy in the Diabetes Control and Complications Trial (DCCT). Methods The DCCT was a multicenter, randomized clinical trial comparing intensive vs conventional treatment in insulin-dependent diabetic patients who had no to moderate nonproliferative retinopathy. Retinopathy severity was assessed in 7-field stereoscopic fundus photographs taken at baseline and every 6 months. For this study, worsening was defined as progression of 3 steps or more on the Early Treatment Diabetic Retinopathy Study final scale, as the development of soft exudates and/or intraretinal microvascular abnormalities, as the development of clinically important retinopathy, or as any of the above, and was considered "early" if it occurred between baseline and 12-month follow-up visits. Results Early worsening was observed at the 6- and/or 12-month visit in 13.1% of 711 patients assigned to intensive treatment and in 7.6% of 728 patients assigned to conventional treatment (odds ratio, 2.06; P Conclusions In the DCCT, the long-term benefits of intensive insulin treatment greatly outweighed the risks of early worsening. Although no case of early worsening was associated with serious visual loss, our results are consistent with previous reports of sight-threatening worsening when intensive treatment is initiated in patients with long-standing poor glycemic control, particularly if retinopathy is at or…
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An association between rapid glucose lowering and worsening of retinopathy has been reported in patients with type 1 diabetes.
“An association between rapid glucose lowering and worsening of retinopathy has been reported in patients with type 1 diabetes.9,10”
From Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (2016) · cites this paper as [9]
Rapid improvement in blood glucose levels may be associated with transient early worsening of retinopathy or the development of acute painful neuropathy.
“The rate of optimizing blood glucose levels in this group of people should also be individualized as rapid improvement may be associated with transient early worsening of retinopathy or the development of acute painful neuropathy (278,279).”
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- Authors
- The Diabetes Control and Complications Trial Research Group
- Corresponding author
- The Diabetes Control and Complications Trial Research Group
- Venue
- Archives of Ophthalmology
- Publisher
- American Medical Association (AMA)
- Published
- 1998-07-01
- Volume
- 116
- Issue
- 7
- Pages
- 874
- ISSN
- 0003-9950 (ISSN-L)
- OpenAlex
- W4235291177
- Cited by
- 509
- References
- 1
- Citations by year
- 2026: 31 · 2025: 30 · 2024: 30 · 2023: 28 · 2022: 24 · 2021: 26 · 2020: 22 · 2019: 19 · 2018: 30 · 2017: 27 · 2016: 21 · 2015: 14 · 2014: 16 · 2013: 19 · 2012: 18
- FWCI
- 7.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- diabetic retinopathy, retinopathy progression, tight glycemic control, HbA1c, type 1 diabetes, risk factors, proliferative diabetic retinopathy, diabetic macular edema, vision loss, Diabetes Control and Complications Trial, retinopathy severity
- MeSH terms
- Adolescent, Adult, Blood Glucose, Diabetes Mellitus, Type 1, Diabetic Retinopathy, Female, Follow-Up Studies, Humans, Insulin, Male, Prognosis, Risk Factors, Severity of Illness Index, Visual Acuity, Cohort Studies, Incidence
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