Abstract
The visual function and degree of retinopathy was assessed, over a three-year period, in a cohort study of twenty-eight diabetics, in whom glycaemic control was improved by intensive monitoring and supervision of conventional therapies.
With the exception of visual acuity and some tests of visual field sensitivity, there was no significant change in visual functions or retinopathy; with improved control of blood glucose, these two visual functions showed a small initial deterioration and subsequently returned towards starting values. Six subjects required laser photocoagulation for progressive peripheral neovascularisation (including two subjects with peripheral new vessels), the six having a significantly longer duration of diabetes, slightly worse measures of extra-foveal retinal functions and a significantly greater reduction in haemoglobin A1 concentration during the first six months of the study.
In this study, the improvement of blood glucose control by intensive supervision of conventional therapy did not appear to be associated with the significant acute deterioration of visual function or retinopathy that has been reported with the strict diabetic control by multiple daily insulin injections or continuous subcutaneous insulin infusion.
Similar content being viewed by others
Article PDF
References
Pirart J : Diabetes mellitus and its degenerative complications. A prospective study of 4400 patients observed between 1947 and 1973. Diabetes Metab 1977, 3: 97–107, 173-82, 245–56.
Dornan TL, Mann JI, Turner R : Factors protective against retinopathy in insulin dependent diabetics free of retinopathy for 30 years. Br Med J 1982, 285: 1073–7.
Doft BH, Kingsley LA, Orchard TJ, Kuller L, Drash A, Becker D : The association between long-term diabetic control and early retinopathy. Ophthalmology 1984, 91: 763–8.
Engerman RL, Bloodworth JMB, Nelson S : Relationship of microvascular disease in diabetes to metabolic control. Diabetes 1977, 26: 760–79.
Job D, Eschwege E, Guyot-Argenton C, et al.: Effect of multiple daily insulin injections on the course of diabetic retinopathy. Diabetes 1976, 25: 463–9.
Miki E, Fukuda M, Kuzuya T, Kosaka K, Nakao K : Relation of the course of retinopathy to control of diabetes, age and therapeutic agents in diabetic Japanese patients. Diabetes 1969, 18: 773–80.
Lawson PM, Champion MC, Canny C, et al.: Continuous subcutaneous insulin infusion does not prevent progression of proliferative and pre-proliferative retinopathy. BrJ Ophthalmol 1982, 66: 762–6.
Hooymans JMM, Ballagooi EV, Schweitzer NM, Doorenbos H, Reitsma WD, Sluiter WJ : Worsening of diabetic retinopathy with strict . control of blood sugar. Lancet 1982, ii: 438.
Lauritzen T, Frost-Larsen K, Larsen H-W, Deckert T, Steno Study Group. Effect of one year of near normal blood glucose levels on retinopathy in insulin dependent diabetics. Lancet 1983, i: 200–4.
Lauritzen T, Frost-Larsen K, Larson H-W Deckert T, Steno Study Group. The effect of near-normal blood glucose levels upon retinopathy: Two year follow-up. Diabetologia 1983, 25: 174–5.
Dahl-Jorgensen K, Brinchmann-Hansen O, Hanssen KF, Sandvik L, Aagenaes O, Aker Diabetes Group. Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study. Brit MedJ 1985, 290: 811–15.
Kroc Collaborative Study Group. Blood glucose control and the evolution of diabetic retinopathy and albuminuria. A preliminary multicenter trial. New Engl J Med 1984, 311: 365–72.
Friberg TR, Rosenstock J, Sandborn G, Vaghefi A, Raskin P : The effect of long-term near normal glycaemic control on mild diabetic retinopathy. Ophthalmology 1985, 92: 1051–7.
Sonksen PH, Judd SL, Lowy C : Home-monitoring of blood glucose. Lancet 1978, i: 729–32.
Baron MD, Sonksen PH, Shenouda FS : Microcolumn method for HbA1 determination. Lancet 1980, i: 1114–6.
Friedmann AI : Serial analysis of changes in visual field defects employing a new instrument to determine the activity of diseases involving the visual pathways. Ophthalmologia 1966, 152: 1–12.
Oakley N, Hill DW, Joplin GF, et al.: Diabetic retinopathy. 1. The assessment of severity and progress by comparison with a set of standard fundus photographs. Diabetologia 1967, 3: 402–5.
Baker RJ and Nelder JA : The GLIM system. Release 3. Generalised Linear Interactive Modelling. Oxford: Numerical Algorithms Group, 1978.
Holman RR, Dornan TL, Mayon-White V et al.: Prevention of deterioration of renal and sensory-nerve function by more intensive management of insulin-dependent diabetic patients. A two-year randomized prospective study. Lancet 1983, 1: 204–8.
Kohner EM and Dollery CT : The rate of formation and disappearance of microaneurysms in diabetic retinopathy. Europ J Clin Invest 1970, 1: 167–71.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Harrad, R., Plumb, A., Rose, G. et al. Three year prospective study of visual function and retinopathy in diabetics with improved glycaemic control. Eye 1, 744–749 (1987). https://doi.org/10.1038/eye.1987.119
Issue Date:
DOI: https://doi.org/10.1038/eye.1987.119