Abstract | AIMS/HYPOTHESIS: METHODS: This is a retrospective cohort study using the Scottish Care Information - Diabetes database for retinal screening outcomes and HbA1c changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan-Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA1c, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA1c and change in HbA1c on diabetic retinopathy progression was assessed within CSII and MDI cohorts. RESULTS: CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA1c and higher diastolic BP at baseline. There was a larger reduction in HbA1c at 1 year in those on CSII vs MDI (-6 mmol/mol [-0.6%] vs -2 mmol/mol [-0.2%], p < 0.01). Diabetic retinopathy progression occurred in a smaller proportion of adults following commencement of CSII vs continued MDI therapy over mean 2.3 year follow-up (26.5% vs 18.6%, p = 0.0097). High baseline HbA1c (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA1c at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. CONCLUSIONS/INTERPRETATION:
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Authors | Laura J Reid, Fraser W Gibb, Helen Colhoun, Sarah H Wild, Mark W J Strachan, Karen Madill, Baljean Dhillon, Shareen Forbes |
Journal | Diabetologia
(Diabetologia)
Vol. 64
Issue 8
Pg. 1725-1736
(08 2021)
ISSN: 1432-0428 [Electronic] Germany |
PMID | 33966091
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
- Glycated Hemoglobin A
- Hypoglycemic Agents
- Insulin
- hemoglobin A1c protein, human
- Cholesterol
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Topics |
- Adolescent
- Adult
- Blood Pressure
(physiology)
- Child
- Cholesterol
(blood)
- Diabetes Mellitus, Type 1
(diagnosis, drug therapy, physiopathology)
- Diabetic Retinopathy
(diagnosis, drug therapy, physiopathology)
- Disease Progression
- Female
- Glycated Hemoglobin
(metabolism)
- Humans
- Hypoglycemic Agents
(administration & dosage)
- Infusions, Subcutaneous
- Injections, Subcutaneous
- Insulin
(administration & dosage)
- Insulin Infusion Systems
- Male
- Proportional Hazards Models
- Retrospective Studies
- Young Adult
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