Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin
Diabetic retinopathy is one of the well-known causes of blindness worldwide. Improvement in blood glucose is being known to reduce the worsening of diabetic retinopathy. In order to maintain glycemic target, insulin can be administered either by multiple daily insulin injections (MDI) or by continuous subcutaneous insulin infusion (CSII). However, few comparative data exist to evaluate whether treatment with CSII delivers any benefits over MDI. Hence, Laura J. Reid and colleagues conducted research under the title “Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin” published in the Diabetologia journal. The summary of this study is given below:
Objective:
To compare glycemic control and diabetic retinopathy outcomes in T1DM with the use of CSII therapy and multiple daily insulin injections (MDI).
Method:
In this retrospective cohort study, the Scottish Care Information – Diabetes database was used for tracking retinal screening outcomes and HbA1c changes. 204 adults participants were started on CSII therapy between 2013 and 2016, while 211 eligible adults for CSII started MDI therapy in same period. With the use of Kaplan–Meier curves, diabetic retinopathy progression was plotted for CSII and MDI cohorts. The outcomes were adjusted for age, baseline HbA1c, sex, blood pressure, smoking status,
cholesterol, and socioeconomic quintile before comparing it using multivariate Cox regression analysis. The impact of HbA1c at baseline and change in HbA1c on diabetic retinopathy progression was evaluated within CSII and MDI cohorts.
Findings:
Initiation of CSII therapy caused reduced retinopathy progression as compared to MDI therapy, investigators report. Additionally, in the CSII group, no association was found between the diabetic retinopathy progression and baseline HbA1c. The reduced frequency was found in the hypoglycemic episodes with CSII therapy.
Limitation:
There is tremendous limitation highlighted by authors such as over the study period timings of retinal imaging and HbA1c collection were’nt uniform, there was no randomization between participants to receive either CSII or MDI therapy resulting in potential confounding and allocation bias, HbA1c data is the only Glycaemic analysis conducted. Finally, results might not be generalizable as it was conducted with a white population of three diabetes centers.
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