Oliver Niels Klefter1,2, Eva Hommel3, Inger Christine Munch2,4, Kirsten Nørgaard5, Sten Madsbad2,5, Michael Larsen1,2. 1. Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark. 2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 3. Steno Diabetes Center, Gentofte, Denmark. 4. Department of Ophthalmology, Roskilde Hospital, Roskilde, Denmark. 5. Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Abstract
PURPOSE: To investigate changes in retinal metabolism, function, structure and morphology in relation to initiation of insulin pump therapy (continuous subcutaneous insulin infusion, CSII). METHODS:Visual acuity, retinopathy level, dark adaptation kinetics, retinal and subfoveal choroidal thickness, macular perfusion velocities, retinal vessel diameters and blood oxygen saturations were measured at baseline and after 1, 4, 16, 32 and 52 weeks in 31 patients with type 1 diabetes who started CSII and 20 patients who continued multiple daily insulin injections (MDI). RESULTS: One year of CSII reduced haemoglobin A1c (HbA1c ) by 1.6% (17.8 mmol/mol) compared with 0.3% (3.1 mmol/mol) in the MDI group (p < 0.0001). Central retinal thickness increased by 1.5% in the CSII group (within-group p = 0.0098; between-group p = 0.063) without producing macular oedema. No detectable change was found in any other primary outcome measure. The proportion of patients with retinopathy worsening did not differ between groups. At baseline, longer disease duration was associated with higher retinal artery oxygen saturation (p = 0.014) and lower macular venous perfusion velocity (p = 0.045). CONCLUSION: One year of CSII led to an HbA1c reduction relative to continued MDI and a small increase in retinal thickness but not to early retinopathy worsening or to changes in retinal vascular, structural or functional characteristics. Longer duration of type 1 diabetes appears to be associated with lower macular venous perfusion velocity and higher retinal artery oxygen saturation. The latter could potentially reflect cumulative glycaemia.
RCT Entities:
PURPOSE: To investigate changes in retinal metabolism, function, structure and morphology in relation to initiation of insulin pump therapy (continuous subcutaneous insulin infusion, CSII). METHODS: Visual acuity, retinopathy level, dark adaptation kinetics, retinal and subfoveal choroidal thickness, macular perfusion velocities, retinal vessel diameters and blood oxygen saturations were measured at baseline and after 1, 4, 16, 32 and 52 weeks in 31 patients with type 1 diabetes who started CSII and 20 patients who continued multiple daily insulin injections (MDI). RESULTS: One year of CSII reduced haemoglobin A1c (HbA1c ) by 1.6% (17.8 mmol/mol) compared with 0.3% (3.1 mmol/mol) in the MDI group (p < 0.0001). Central retinal thickness increased by 1.5% in the CSII group (within-group p = 0.0098; between-group p = 0.063) without producing macular oedema. No detectable change was found in any other primary outcome measure. The proportion of patients with retinopathy worsening did not differ between groups. At baseline, longer disease duration was associated with higher retinal artery oxygen saturation (p = 0.014) and lower macular venous perfusion velocity (p = 0.045). CONCLUSION: One year of CSII led to an HbA1c reduction relative to continued MDI and a small increase in retinal thickness but not to early retinopathy worsening or to changes in retinal vascular, structural or functional characteristics. Longer duration of type 1 diabetes appears to be associated with lower macular venous perfusion velocity and higher retinal artery oxygen saturation. The latter could potentially reflect cumulative glycaemia.
Authors: Kathryn Linton; Roland H Stimson; Anna R Dover; Shareen Forbes; Karen Madill; Roxanne Annoh; Mark W J Strachan; J A McKnight; Rohana J Wright; Fraser W Gibb Journal: J Diabetes Sci Technol Date: 2021-02-19
Authors: Muhammad Al-Dalla Ali; Roland H Stimson; Anna R Dover; Shareen Forbes; Roxanne Annoh; Karen Madill; Fraser W Gibb Journal: BMJ Open Diabetes Res Care Date: 2020-11
Authors: Laura J Reid; Fraser W Gibb; Helen Colhoun; Sarah H Wild; Mark W J Strachan; Karen Madill; Baljean Dhillon; Shareen Forbes Journal: Diabetologia Date: 2021-05-08 Impact factor: 10.122