Insulin treatment of elderly Type 2 diabetic patients: Effects on retinopathy

Insulin treatment is reportedly associated with the transient progression o f retinopathy, possibly with the development of macular oedema in middle-ag ed Type 2 diabetic patients. The purpose of this study was to investigate t he effect of insulin treatment on eye-grounds in elderly (> 65-year-old) Ty pe 2 diabetic patients with secondary failure of oral antidiabetic-drug the rapy. Eye examinations were performed in 37 patients randomized to insulin (n = 19) or sulphonylurea (n = 16) treatment and re-investigated after one year. Insulin treatment reduced HbA1c from 9.3 % to 7.3 % (p < 0.001) after one year. In the sulphonylurea-treated group, HbA1c did not change (9.1 vs . 9.3 %). AT the start, 65 % of the patients had retinopathy, and after one year progression was noted in 7/35 patients (20 %; 5 insulin- and 2 sulpho nylurea-treated). In the insulin-treated group, the 5 patients with progres sion had higher initial fasting blood-glucose levels than other patients in the group (15.6 vs 13.1 mmol/L, p < 0.05). Initial HbA1c levels did not di ffer between the groups (9.8 vs. 9.1 %, n.s.), nor the reduction of HhA1c l evels during treatment (2.2 vs. 7.3 %, n.s.). Thus, diabetic retinopathy in this study was common among elderly Type 2 diabetic patients. The progress ion of retinopathy may in fact be associated with insulin treatment or impr ovement of metabolic control.