Association of continuous subcutaneous insulin therapy and diabetic retinopathy in type 1 diabetes: A national cohort study

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM Journal of diabetes and its complications Pub Date : 2024-07-25 DOI:10.1016/j.jdiacomp.2024.108830

Anne S. Thykjær , Louise Rosengaard , Nis Andersen , Jens Andresen , Javad Hajari , Steffen Heegaard , Kurt Højlund , Ryo Kawasaki , Caroline S. Laugesen , Sören Möller , Frederik N. Pedersen , Katja Schielke , Lonny M. Stokholm , Jakob Grauslund

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Abstract

Aim

This study aimed to investigate the short-and long-term effect on diabetic retinopathy (DR) in individuals with type 1 diabetes treated with continuous subcutaneous insulin injections (CSII) compared to those using multiple daily injections (MDI).

Methods

We conducted a register-based matched cohort study utilizing data from the Danish Registry of Diabetic Retinopathy as well as several other national Danish health registers. Our cohort consisted of all individuals with type 1 diabetes who attended the Danish screening program for DR from 2013 to 2022. We included individuals registered with CSII treatment, and compared them to individuals using MDI, matched by age, sex, and DR level. Cox regression analysis was performed to evaluate the outcomes.

Results

The study included 674 individuals treated with CSII and 2006 matched MDI users. In our cohort 53.4 % were female and median age was 36 (IQR 27–47). Average follow-up risk-time was 4.8 years. There was no difference in the risk of DR worsening between the CSII group and MDI group (HR 1.05 [95%CI 0.91; 1.22], p = 0.49). However, an increased risk of focal photocoagulation was observed in the CSII group (HR 2.40 [95%CI 1.11; 5.19], p = 0.03).

Conclusions

Our findings indicate that CSII treatment does not confer a significant difference in the overall short- and long-term risk of DR worsening or ocular intervention compared to MDI treatment. These results provide insights into the DR outcomes of CSII treatment in individuals with type 1 diabetes.

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1 型糖尿病患者持续皮下注射胰岛素治疗与糖尿病视网膜病变的关系：全国队列研究

方法我们利用丹麦糖尿病视网膜病变登记处以及其他几个丹麦国家健康登记处的数据，开展了一项基于登记的匹配队列研究。我们的队列包括 2013 年至 2022 年期间参加丹麦 DR 筛查项目的所有 1 型糖尿病患者。我们纳入了接受 CSII 治疗的登记患者，并将他们与使用 MDI 的患者进行了比较，这些患者的年龄、性别和 DR 水平均与我们的研究相匹配。研究纳入了 674 名接受 CSII 治疗的患者和 2006 名匹配的 MDI 使用者。在我们的队列中，53.4% 为女性，中位年龄为 36 岁（IQR 27-47）。平均随访风险时间为 4.8 年。CSII 组和 MDI 组的 DR 恶化风险没有差异（HR 1.05 [95%CI 0.91; 1.22]，P = 0.49）。结论我们的研究结果表明，与 MDI 治疗相比，CSII 治疗在 DR 恶化或眼部干预的短期和长期总体风险方面没有显著差异。这些结果让我们对 CSII 治疗 1 型糖尿病患者 DR 的结果有了更深入的了解。

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来源期刊

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.