Verrillo A, de Teresa A, Martino C, Verrillo L, di Chiara G
Institute of Internal Medicine, II School of Medicine, University of Naples, Italy.
Diabetes Res. 1988 Jun;8(2):71-6.
Thirty-eight patients with insulin dependent diabetes mellitus who had background retinopathy and no residual endogenous insulin secretion as assessed by plasma C-peptide determinations, were randomized to either conventional insulin treatment or to more intensive glucose control using ultralente insulin as basal cover and soluble insulin at mealtimes and were followed for five years. Plasma glucose profile and glycosylated hemoglobin were determined every eight weeks. Eye examinations were performed at the start of the study and after one, three and five years. Age, duration of diabetes, insulin dosage, glycemic control were comparable in the two groups. The mean plasma glucose profile was similar at entry in both groups and did not change in the conventionally-treated group. Mean plasma glucose profile 11.2 +/- 1 mmol/l with glycosylated hemoglobin level 10.7 +/- 0.3% fell to 7.9 +/- 0.4 mmol/l and 8.7 +/- 0.5% respectively during intensive treatment. Retinal morphology deteriorated during the follow-up with no significant differences between patients under unchanged conventional treatment and intensive insulin regimen. Proliferative retinopathy developed in six patients--three of these were under intensive insulin treatment. These data suggest that substantial long-term improvement of glycemic control does not affect progression of background retinopathy even when it is mild. The evolution of established retinopathy in insulin dependent diabetic patients is not only a function of poor glycemic control; other factors, either intrinsic or environmental, must also be important.
38例胰岛素依赖型糖尿病患者，伴有背景性视网膜病变，且根据血浆C肽测定评估无内源性胰岛素分泌残留，被随机分为常规胰岛素治疗组或采用超长效胰岛素作为基础覆盖、餐时使用可溶性胰岛素进行更强化血糖控制组，并随访5年。每8周测定血浆葡萄糖谱和糖化血红蛋白。在研究开始时以及1年、3年和5年后进行眼部检查。两组患者的年龄、糖尿病病程、胰岛素剂量、血糖控制情况相当。两组入组时的平均血浆葡萄糖谱相似，常规治疗组未发生变化。强化治疗期间，平均血浆葡萄糖谱从11.2±1 mmol/l、糖化血红蛋白水平从10.7±0.3%分别降至7.9±0.4 mmol/l和8.7±0.5%。随访期间视网膜形态恶化，常规治疗不变的患者与强化胰岛素治疗方案的患者之间无显著差异。6例患者发生增殖性视网膜病变，其中3例接受强化胰岛素治疗。这些数据表明，即使血糖控制长期显著改善，也不会影响轻度背景性视网膜病变的进展。胰岛素依赖型糖尿病患者已确诊的视网膜病变的进展不仅取决于血糖控制不佳；其他内在或环境因素也一定很重要。
