Progression of Diabetic Retinopathy After Initiation of Automated Insulin Delivery System in Adults With Type 1 Diabetes

Overview

Journal J Diabetes Sci Technol

Specialty Endocrinology

Date 2025 Feb 14

PMID 39950376

Authors

Kagan E Karakus

Halis K Akturk

Janet K Snell-Bergeon

Viral N Shah

Affiliations

Soon will be listed here.

Abstract

Background: To evaluate the progression of diabetic retinopathy (DR) after the initiation of automated insulin delivery (AID) systems in adults with type 1 diabetes (T1D).

Methods: In this longitudinal study with 152 adults, retinal exams and clinical variables were collected before and after AID initiation up to 2.7 years. The DR worsening was defined as an increase in Early Treatment of Diabetic Retinopathy Study (ETDRS) scores or qualitative retinal exam.

Results: A total of 152 adults with mean age of 42 years (57% female), 26 years of T1D duration, and mean baseline HbA of 7.6% (60 mmol/mol) were included in this analysis. Of 152 adults with T1D, 42 (28%) adults had DR worsening after AID initiation. After adjusting for age, diabetes duration, and sex, baseline HbA (odds ratio [OR] = 2.1 [1.34-3.04]) and low-density lipoprotein cholesterol (LDL-C) >100 mg/dL with HbA >8% (OR = 3.33 [1.12-9.91]) were associated with two- and three-fold increased risk for DR worsening, respectively. The decline of HbA with AID initiation between DR worsening and no-DR worsening groups was not significant (-0.38 ± 1.2% vs -0.47 ± 0.9%; = .6).

Conclusions: Higher baseline HbA with LDL-C >100 mg/dL may be associated with DR worsening after initiation of AID systems in T1D. Those with elevated HbA should get periodic ophthalmic examination after AID initiation to detect progression of DR. Prompt diagnosis may result in timely treatment.

References

Bourry J, Courteville H, Ramdane N, Drumez E, Duhamel A, Subtil D . Progression of Diabetic Retinopathy and Predictors of Its Development and Progression During Pregnancy in Patients With Type 1 Diabetes: A Report of 499 Pregnancies. Diabetes Care. 2020; 44(1):181-187. DOI: 10.2337/dc20-0904. View

Vilsboll T, Bain S, Leiter L, Lingvay I, Matthews D, Simo R . Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy. Diabetes Obes Metab. 2017; 20(4):889-897. PMC: 5888154. DOI: 10.1111/dom.13172. View

Marso S, Bain S, Consoli A, Eliaschewitz F, Jodar E, Leiter L . Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016; 375(19):1834-1844. DOI: 10.1056/NEJMoa1607141. View

Bergenstal R, Garg S, Weinzimer S, Buckingham B, Bode B, Tamborlane W . Safety of a Hybrid Closed-Loop Insulin Delivery System in Patients With Type 1 Diabetes. JAMA. 2016; 316(13):1407-1408. DOI: 10.1001/jama.2016.11708. View

Bain S, Klufas M, Ho A, Matthews D . Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review. Diabetes Obes Metab. 2018; 21(3):454-466. PMC: 6587545. DOI: 10.1111/dom.13538. View

. Blood glucose control and the evolution of diabetic retinopathy and albuminuria. A preliminary multicenter trial. N Engl J Med. 1984; 311(6):365-72. DOI: 10.1056/NEJM198408093110604. View

Akil H, Burgess J, Nevitt S, Harding S, Alam U, Burgess P . Early Worsening of Retinopathy in Type 1 and Type 2 Diabetes After Rapid Improvement in Glycaemic Control: A Systematic Review. Diabetes Ther. 2021; 13(1):1-23. PMC: 8776958. DOI: 10.1007/s13300-021-01190-z. View

Russell S, Beck R, Damiano E, El-Khatib F, Ruedy K, Balliro C . Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. N Engl J Med. 2022; 387(13):1161-1172. PMC: 10028490. DOI: 10.1056/NEJMoa2205225. View

ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D . 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2023. Diabetes Care. 2022; 46(Suppl 1):S203-S215. PMC: 9810462. DOI: 10.2337/dc23-S012. View

10.

Brown S, Forlenza G, Bode B, Pinsker J, Levy C, Criego A . Multicenter Trial of a Tubeless, On-Body Automated Insulin Delivery System With Customizable Glycemic Targets in Pediatric and Adult Participants With Type 1 Diabetes. Diabetes Care. 2021; 44(7):1630-1640. PMC: 8323171. DOI: 10.2337/dc21-0172. View

11.

. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991; 98(5 Suppl):786-806. View

12.

Brown S, Kovatchev B, Raghinaru D, Lum J, Buckingham B, Kudva Y . Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med. 2019; 381(18):1707-1717. PMC: 7076915. DOI: 10.1056/NEJMoa1907863. View

13.

Breton M, Kanapka L, Beck R, Ekhlaspour L, Forlenza G, Cengiz E . A Randomized Trial of Closed-Loop Control in Children with Type 1 Diabetes. N Engl J Med. 2020; 383(9):836-845. PMC: 7920146. DOI: 10.1056/NEJMoa2004736. View

14.

. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol. 1998; 116(7):874-86. DOI: 10.1001/archopht.116.7.874. View

15.

Feldman-Billard S, Larger E, Massin P . Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes. Diabetes Metab. 2017; 44(1):4-14. DOI: 10.1016/j.diabet.2017.10.014. View

16.

Andersen S, Witte D, Dalsgaard E, Andersen H, Nawroth P, Fleming T . Risk Factors for Incident Diabetic Polyneuropathy in a Cohort With Screen-Detected Type 2 Diabetes Followed for 13 Years: ADDITION-Denmark. Diabetes Care. 2018; 41(5):1068-1075. DOI: 10.2337/dc17-2062. View

17.

Eid S, Sas K, Abcouwer S, Feldman E, Gardner T, Pennathur S . New insights into the mechanisms of diabetic complications: role of lipids and lipid metabolism. Diabetologia. 2019; 62(9):1539-1549. PMC: 6679814. DOI: 10.1007/s00125-019-4959-1. View

18.

ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D . 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2022; 46(Suppl 1):S158-S190. PMC: 9810475. DOI: 10.2337/dc23-S010. View

19.

Bisio A, Gonder-Frederick L, McFadden R, Chernavvsky D, Voelmle M, Pajewski M . The Impact of a Recently Approved Automated Insulin Delivery System on Glycemic, Sleep, and Psychosocial Outcomes in Older Adults With Type 1 Diabetes: A Pilot Study. J Diabetes Sci Technol. 2021; 16(3):663-669. PMC: 9294584. DOI: 10.1177/1932296820986879. View