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 good glycemic control has been shown to retard development of retinopathy even though temporary progression has occurred. Few data have been available from patients with non-insulin-dependent diabetes mellitus (NIDDM). To determine the impact of improved glycemic control on retinopathy in patients with NIDDM, we examined, in a case-control study, the progression of retinopathy in 94 patients who changed treatment from oral antihyperglycemic agents to insulin. RESEARCH DESIGN AND METHODS - We used the Wisconsin retinopathy scale and related progression of retinopathy during a 2-year observation period to changes in HbA(Ic) after institution of insulin therapy. RESULTS - Progression of retinopathy greater than or equal to 3 levels occurred in 21% of the patients and was significantly more common in the patient group in which HbA(Ic) was lowered greater than or equal to 3% compared with progression in the 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 worsening of retinopathy in patients with NIDDM.