Effects of Intensified Insulin Treatment on Various Lesions of Diabetic Retinopathy

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Mild background retinopathy was studied prospectively during long-term strict blood glucose control in insulin-dependent diabetes mellitus. Forty-five subjects (21 women and 24 men with a mean age of 26.3 years and a mean duration of diabetes of 12.8 years) were randomly assigned to continuous subcutaneous insulin infusion, multiple injections, and conventional two-injection treatment. Eyes were examined two months before treatment, at the beginning of treatment, and after three, six, and 12 months. A progressive deterioration was found in the two-injection group during the study, but no significant changes were found in patients receiving multiple injections. A transient deterioration occurred after three months of continuous subcutaneous insulin infusion. Soft exudates appeared in 50% of the patients on the two intensified regimens, but no exudates were found in patients given conventional treatment. The morphologic changes seemed to be related to a large and rapid decrease in mean blood glucose or to an increased frequency of hypoglycemia, or both.

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    This study was supported by grants from the Norwegian Council for Science and the Humanities, the Norwegian Diabetes Association, the Norwegian Council on Cardiovascular Diseases, the University of Oslo, and the Jahres Medical Foundation.

    Reprint requests to Olaf Brinchmann-Hansen, M.D., Eye Department, Ullevaal Hospital, Kirkeveien 166, 0450 Oslo 4, Norway.

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