PROGRESSION OF RETINOPATHY ALTER CHANGE OF TREATMENT FROM ORAL ANTIHYPERGLYCEMIC AGENTS TO INSULIN IN PATIENTS WITH NIDDM

OBJECTIVE - In insulin-dependent diabetes mellitus, institution of goo d glycemic control has been shown to retard development of retinopathy even though temporary progression has occurred. Few data have been av ailable from patients with non-insulin-dependent diabetes mellitus (NI DDM). To determine the impact of improved glycemic control on retinopa thy in patients with NIDDM, we examined, in a case-control study, the progression of retinopathy in 94 patients who changed treatment from o ral antihyperglycemic agents to insulin. RESEARCH DESIGN AND METHODS - We used the Wisconsin retinopathy scale and related progression of re tinopathy during a 2-year observation period to changes in HbA(Ic) aft er institution of insulin therapy. RESULTS - Progression of retinopath y greater than or equal to 3 levels occurred in 21% of the patients an d was significantly more common in the patient group in which HbA(Ic) was lowered greater than or equal to 3% compared with progression in t he group in which HbA(Ic) was lowered <3% (P = 0.0001; relative risk 3 .2; 95% confidence interval 1.5-6.9). CONCLUSIONS - Improved glycemic control as achieved by insulin therapy may be associated with worsenin g of retinopathy in patients with NIDDM.