Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK.
BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
Diabetologia. 2021 Aug;64(8):1725-1736. doi: 10.1007/s00125-021-05456-w. Epub 2021 May 8.
AIMS/HYPOTHESIS: We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI).
This is a retrospective cohort study using the Scottish Care Information - Diabetes database for retinal screening outcomes and HbA 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 HbA, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA and change in HbA on diabetic retinopathy progression was assessed within CSII and MDI cohorts.
CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA and higher diastolic BP at baseline. There was a larger reduction in HbA 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 HbA (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 HbA at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group.
CONCLUSIONS/INTERPRETATION: CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA. Progression of diabetic retinopathy over 3 years was not associated with a change in HbA.
目的/假设：我们旨在比较 1 型糖尿病患者在接受持续皮下胰岛素输注 (CSII) 治疗后与继续接受多次胰岛素注射 (MDI) 治疗的患者的糖尿病视网膜病变结果。
这是一项回顾性队列研究，使用苏格兰护理信息 - 糖尿病数据库评估 204 名在 2013 年至 2016 年间开始接受 CSII 治疗的成年人和 211 名在同一时期有资格接受 CSII 但继续接受 MDI 治疗的成年人的视网膜筛查结果和 HbA 变化。使用 Kaplan-Meier 曲线为 CSII 和 MDI 队列绘制糖尿病视网膜病变进展（从基线分级开始，至少有一级恶化的时间），并使用多变量 Cox 回归分析调整年龄、性别、基线 HbA、血压、胆固醇、吸烟状况和社会经济五分位数来比较结果。评估 CSII 和 MDI 队列中基线 HbA 和 HbA 变化对糖尿病视网膜病变进展的影响。
CSII 参与者明显更年轻，来自社会贫困程度较低的地区，并且基线 HbA 和舒张压较低。与 MDI 相比，CSII 组在 1 年内 HbA 降低幅度更大（-6mmol/mol [-0.6%] 与 -2mmol/mol [-0.2%]，p < 0.01）。在平均 2.3 年的随访中，与继续 MDI 治疗相比，CSII 治疗后发生糖尿病视网膜病变进展的成年人比例较小（26.5%与 18.6%，p = 0.0097）。在 MDI 组中，高基线 HbA（75mmol/mol [9%]）与糖尿病视网膜病变进展相关（p = 0.0049），但在 CSII 组中无相关性（p = 0.93）。无论基线血糖状态如何，随访时 HbA 的变化均未显著影响两组的糖尿病视网膜病变进展。
结论/解释：与继续 MDI 治疗相比，CSII 与糖尿病视网膜病变进展减少相关，并且可能对高基线 HbA 的患者预防糖尿病视网膜病变进展有保护作用。3 年内糖尿病视网膜病变的进展与 HbA 的变化无关。
