Progression of retinopathy after improved metabolic control in type 2 diabetic patients - Relation to IGF-1 and hemostatic variables

OBJECTIVE - To determine the impact of improved glycemic control on the dev elopment and progression of retinopathy after the institution of insulin th erapy in patients with type 2 diabetes and to assess the relation to IGF-1 and hemostatic variables. RESEARCH DESIGN AND METHODS - In a prospective observational study: 45 type 2 diabetic patients were examined at baseline and 1, 3, 6, 12, and 24 mont hs after change to insulin therapy: Retinopathy was graded on fundus photog raphs using the Wisconsin scale; HbA(1c), IGF-1 and hemostatic variables we re measured. RESULTS - During the observation period of 2 years, 23 patients progressed in the retinopathy scale; 8 progressed greater than or equal to 3 lei els. After 2)ears of insulin treatment, HbA(1c) and IGF-1 were significantly low er than at baseline, whereas the hemostatic variables had not changed signi ficantly! Progression of retinopathy greater than or equal to 3 levels was related to the degree of HbA(1c) reduction, the duration of diabetes, a hig her prothrombin fragment 1+2 levels (F1+2), but not to other hemostatic var iables or IGF-1. The relative risk for progression greater than or equal to 3 levels was 2.6 when HbA(1c) had been reduced greater than or equal to 3 percent units (95% CI 1.1-6.1) CONCLUSIONS - The magnitude of improvement of HbA(1c) by the institution of insulin treatment over a 2-year period may be associated with progression of retinopathy in patients with type 2 diabetes.