Early Worsening of Diabetic Retinopathy following INT intensive insulin therapy While INT resulted in long-term risk reduction in the progression of DR, increased progression of DR did occur in the first year of follow-up after initiation of INT for some subjects (13). This phenomenon, termed “early worsening,” underlies the crossing of the cumulative retinopathy progression curves for INT and CON between 2 and 3 years in the secondary intervention group (Fig. 2). Early worsening occurred most frequently in subjects with more advanced baseline DR, and was predominantly driven by the development of cotton wool spots and intraretinal microvascular abnormalities. Risk factors for early worsening included higher HbA1c levels at entrance to the study, magnitude of HbA1c reduction, duration of diabetes, and the baseline level of DR (13). Early worsening occurred within 12 months in 13.1% of 711 subjects assigned to INT and in 7.6% of 728 subjects assigned to CON. Crossover occurred at 18 months, with 51% of the INT group and 55% of the CON group showing recovery (13). The long-term benefit of INT and the limited risk associated with early worsening in most subjects strongly support the initiation of INT in most cases. Careful retinal monitoring during the initiation of INT, especially in individuals with significant retinopathy or high HbA1c at baseline, may be indicated. care.diabetesjournals.org/content/37/1/17.full
Posted on: Tue, 18 Mar 2014 15:58:56 +0000
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