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September 1988

The Response of Diabetic Retinopathy to 41 Months of Multiple Insulin Injections, Insulin Pumps, and Conventional Insulin Therapy

Author Affiliations

From the Department of Ophthalmology, Ullevȧl University Hospital (Dr Brinchmann-Hansen); the Departments of Medicine B (Dr Hanssen) and Pediatrics (Dr Dahl-Jørgensen), Aker University Hospital; and the Medstat-Center for Medical Statistics (Mr Sandvik), Oslo.

Arch Ophthalmol. 1988;106(9):1242-1246. doi:10.1001/archopht.1988.01060140402041

• Forty-five diabetic patients were randomized and treated with continuous subcutaneous insulin infusion (CSII), multiple insulin injections (MI), or conventional insulin treatment (CIT) for 41 months. Near-normoglycemia was obtained with CSII and MI but not with CIT. A transient increase in microaneurysms and hemorrhages was seen at three months in CSII-treated patients. After 41 months, a moderate progression in microaneurysms and hemorrhages was registered, as assessed from fundus photographs, in all treatment groups. Fluorescein angiograms indicated a tendency (not statistically significant) to retarded progression of retinopathy in MI- and CSII-treated patients compared with CIT-treated patients. Soft exudates developed after three to six months of rapid tightening of metabolic control in 50% of patients on CSII and MI regimens. Those patients who had soft exudates had a slower progression of retinopathy three years later than those who did not develop soft exudates. Transient progression of retinopathy may be related to fluctuations in blood glucose levels, although a favorable effect of long-term improved metabolic control was not documented.

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