Abstract / Description of output
AIMTo compare diabetic retinopathy (DR) outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy compared to people receiving continuing therapy with multiple daily insulin injections (MDI).
RESEARCH DESIGN AND METHODSRetrospective cohort study using the Scottish diabetes database for retinal screening outcomes and HbA1c changes in 204 adults commenced on CSII therapy between 2013-16, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. DR progression (time to minimum one grade worsening in DR from baseline grading) was plotted for CSII and MDI cohorts using Kaplan-Meier curves, and outcomes compared using multivariate cox regression analysis adjusting for age, gender, baseline HbA1c, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA1c and change in HbA1c on DR progression was assessed within CSII and MDI cohorts.
RESULTSCSII participants were significantly younger, from less socially deprived areas and had lower HbA1c and higher diastolic BP at baseline. There was a larger reduction in HbA1c at one year in those on CSII versus MDI (-6mmol/mol (-0.6%) versus -2mmol/mol (-0.2%), p<0.01). DR progression occurred in a smaller proportion of adults following commencement of CSII versus continued MDI therapy over mean 2.3 year follow-up (26.5% versus 18.6%, p=0.0097). High baseline HbA1c (75mmol/mol (9%)) was associated with DR progression in MDI group (p=0.0049) but not CSII group (p=0.93). Change in HbA1c at follow up, irrespective of baseline glycaemic status, did not significantly affect DR progression in either group.
CONCLUSIONSCSII was associated with reduced DR progression compared to continued MDI therapy, and may be protective against DR progression for those with high baseline HbA1c. Progression of DR over three years was not associated with a change in HbA1c.
RESEARCH DESIGN AND METHODSRetrospective cohort study using the Scottish diabetes database for retinal screening outcomes and HbA1c changes in 204 adults commenced on CSII therapy between 2013-16, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. DR progression (time to minimum one grade worsening in DR from baseline grading) was plotted for CSII and MDI cohorts using Kaplan-Meier curves, and outcomes compared using multivariate cox regression analysis adjusting for age, gender, baseline HbA1c, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA1c and change in HbA1c on DR progression was assessed within CSII and MDI cohorts.
RESULTSCSII participants were significantly younger, from less socially deprived areas and had lower HbA1c and higher diastolic BP at baseline. There was a larger reduction in HbA1c at one year in those on CSII versus MDI (-6mmol/mol (-0.6%) versus -2mmol/mol (-0.2%), p<0.01). DR progression occurred in a smaller proportion of adults following commencement of CSII versus continued MDI therapy over mean 2.3 year follow-up (26.5% versus 18.6%, p=0.0097). High baseline HbA1c (75mmol/mol (9%)) was associated with DR progression in MDI group (p=0.0049) but not CSII group (p=0.93). Change in HbA1c at follow up, irrespective of baseline glycaemic status, did not significantly affect DR progression in either group.
CONCLUSIONSCSII was associated with reduced DR progression compared to continued MDI therapy, and may be protective against DR progression for those with high baseline HbA1c. Progression of DR over three years was not associated with a change in HbA1c.
| Original language | English |
|---|---|
| Journal | Diabetologia |
| Early online date | 8 May 2021 |
| DOIs | |
| Publication status | E-pub ahead of print - 8 May 2021 |