Long-term progression of retinopathy after initiation of insulin therapy in Type�2 diabetes: an observational study
Open accessAbstract
Aims/hypothesis Universal worsening of retinopathy after starting insulin therapy in Type 2 diabetes has been suggested in previous work. Methods We studied 294 such patients for up to 5 years to evaluate retinal changes and define the factors affecting progression of retinopathy. Yearly retinal photographs were graded using the EURODIAB system. Results Prior to insulin therapy, 26.2% (77/294) of the patients had minimal non-proliferative diabetic retinopathy (NPDR), 3.7% (n=11) had moderate NPDR and 1% (n=3) had severe NPDR. Over the first 3 years of insulin therapy, significant progression occurred in 36 subjects (12.6%). This comprised 5/193 (2.6%) without any retinopathy at baseline, 22/77 (28.5%) with minimal NPDR and 6/11 with moderate NPDR (54.5%) (chi2=56.1, p<0.001). In a control group of 70 patients who remained on oral hypoglycaemic agents, nine patients had significant worsening of retinopathy over 3 years. Over 5 years, 22/127 (17.3%) of patients (9/95 without and 13/32 with retinopathy at baseline [chi2=16.2, p<0.001]) had significant progression of retinopathy. Higher baseline HbA1c (p=0.002) and lower initial decrease in HbA1c (p=0.007) were each independent predictors of greater retinopathy progression over this period. There was no significant worsening of visual acuity in patients whose retinopathy progressed. Conclusions/interpretation After initiation of insulin treatment in Type 2 diabetes, clinically significant worsening of retinopathy over a 3-year period was uncommon in those with no retinopathy (2.6%) but occurred in 31.8% of patients with any retinopathy at baseline. The risk of serious worsening of retinopathy after insulin therapy is started in all patients with Type 2 diabetes may have been previously overestimated.
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In a post-hoc analysis of the Look AHEAD dataset, a 10% weight loss in the first year, similar to that in DiRECT, was associated with a 21% decrease in occurrence of cardiovascular outcomes over a median follow-up of 10.2 years.
“In a post-hoc analysis of the Look AHEAD dataset, a 10% weight loss in the first year, similar to that in the DiRECT, was associated with a 21% decrease in occurrence of cardiovascular outcomes over a median follow-up of 10•2 years.34”
From Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial (2018) · cites this paper as [34]
The Subject characteristics section reports retinopathy outcomes over three and five years after insulin initiation, not cardiovascular outcomes after weight loss. Searches for Look AHEAD, DiRECT, 10% weight loss, the 21% decrease, and 10.2-year follow-up found no passage addressing the claim in our copy; page numbers were not available. (LLM, conf=0.78)
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- Authors
- Arun, C. S., Pandit, R., & Taylor, R.
- Affiliations
- Newcastle University (GB)
- Corresponding author
- Arun, C.S.
- ORCID
- Venue
- Diabetologia
- Published
- 2004-07-28
- Volume
- 47
- Issue
- 8
- Pages
- 1380-4
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2051682994
- Cited by
- 37
- References
- 21
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 7 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetic retinopathy, retinopathy progression, insulin therapy, type 2 diabetes, non-proliferative diabetic retinopathy, HbA1c, glycemic control, oral antidiabetic drugs, visual acuity
- MeSH terms
- Administration, Oral, Aged, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Visual Acuity, Incidence, Disease Progression
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