[Risk factors for the development of diabetic retinopathy in patients with insulin-dependent diabetes mellitus treated with continuous subcutaneous insulin infusion]

Abstract

During a one year observation period, the retinal status, glycosylated hemoglobin levels (HbA1), hypoglycemias, lipid values, blood pressure and clinical abnormalities of IDDM (insulin dependent diabetes mellitus) patients treated by CSII (continuous subcutaneous insulin infusion) were documented. In 70 (out of n = 81) patients 137 retinal follow-up examinations were performed and evaluated. In 86.1% of those patients, CSII appeared to have a positive influence on their retinal status. In 14.6% (8.6% with background retinopathy + 5.8% with proliferative retinopathy) improvement of a pre-existing retinopathy could be seen. The diabetes duration itself seemed to have no influence on development or progression of diabetic retinopathy, but elevation of HbA1 or serum triglyceride levels, as well as elevated systolic blood pressure leaded (on a medium term base) to statistically significant deterioration or development of retinopathy. In addition, hypoglycemias and impaired renal function have to be seen as risk factors potentiating each other.

Conclusion: Besides the treatment of cardiovascular risk factors, getting normal HbA1 values while avoiding hypoglycemia must be the major aim in therapy management to prevent microangiopathy. In certain cases, even patients with severe retinopathy might benefit from CSII. When blood sugar levels are carefully lowered during the first months, no deterioration of the retinal status is seen in patients with long-term metabolic decompensation.