Intensive insulin therapy may speed up the development of diabetic retinopathy, placing some patients at a higher risk for blindness.
Diabetic retinopathy (DR) remains the leading cause of adult-onset blindness. As a result of prolonged hyperglycemia, retinal perfusion is decreased, blocking the retinal capillaries, and producing vision loss. Previous studies have a positive association between normalization of glycemic levels and reduced DR progression in type 1 and type 2 diabetes patients. However, clinical trials have shown a new phenomenon, "early worsening of diabetic retinopathy," in select type 1 and type 2 diabetes patients. Risk factors include high baseline HbA1c, long duration of diabetes, and DR severity.
Moreover, the patients in these studies had minimal to moderate non-proliferative DR or did not have DR at baseline. Currently used therapies in patients with DR are pan-retinal photocoagulation, pars plana vitrectomy, and silicone oil injection. There is little literature regarding the impact of intensive insulin therapy in patients with proliferative diabetic retinopathy at baseline....
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