Effects of intensive insulin therapy on the retinal microvasculature in patients with type 2 diabetes mellitus: a prospective observational study

Background: We examined the retinal microvascular changes and associated factors in type 2 diabetes mellitus (T2DM) before and after intensive insulin therapy. Methods: This prospective observational study recruited patients with T2DM and divided them into intensive insulin therapy and oral hypoglyc...

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Bibliographic Details
Main Authors: Li, M.-X (Author), Peng, X.-Y (Author), Yang, N. (Author)
Format: Article
Language:English
Published: BioMed Central Ltd 2022
Subjects:
Online Access:View Fulltext in Publisher
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020 |a 14712415 (ISSN) 
245 1 0 |a Effects of intensive insulin therapy on the retinal microvasculature in patients with type 2 diabetes mellitus: a prospective observational study 
260 0 |b BioMed Central Ltd  |c 2022 
856 |z View Fulltext in Publisher  |u https://doi.org/10.1186/s12886-022-02397-9 
520 3 |a Background: We examined the retinal microvascular changes and associated factors in type 2 diabetes mellitus (T2DM) before and after intensive insulin therapy. Methods: This prospective observational study recruited patients with T2DM and divided them into intensive insulin therapy and oral hypoglycemic agent groups. All patients enrolled in this study had diabetes without retinopathy or non-proliferative diabetic retinopathy. Optical coherence tomography angiography (OCTA) was used in all patients before treatment and at 1, 3, and 6 months after treatment. Vessel density (VD) and thickness changes in the macular and optic disc areas were assessed. Results: The study included 36 eyes in the intensive insulin therapy group and 36 in the oral hypoglycemic agent group. One month after treatment, VD in the deep capillary plexus (DCP) and peripapillary capillary VD (ppVD) were significantly decreased by intensification (P = 0.009, 0.000). At three months after treatment, decreases in VD induced by intensification were found in the superficial capillary plexus (SCP), DCP, foveal density in a 300-μm-wide region around the foveal avascular area (FD-300), and ppVD (P = 0.032, 0.000, 0.039, 0.000). Six months after treatment, decreases in VD by intensification were observed in the DCP and ppVD groups (P = 0.000, 0.000). Vessel density showed no significant change in the oral hypoglycemic agent group after treatment. The amount of DCP-VD reduction was correlated with macular thickening (r = 0.348, P = 0.038; r = 0.693, P = 0.000 and r = 0.417, P = 0.011, respectively) after intensive insulin therapy. Conclusions: Insulin-intensive treatment caused a transient reduction in vessel density in the macular and optic disc areas. DCP-VD and ppVD were more susceptible at an earlier stage. Retinal microvasculature monitoring using OCTA is vital for patients with type 2 diabetes receiving intensive insulin therapy. © 2022, The Author(s). 
650 0 4 |a antidiabetic agent 
650 0 4 |a complication 
650 0 4 |a Diabetes Mellitus, Type 2 
650 0 4 |a Fluorescein Angiography 
650 0 4 |a fluorescence angiography 
650 0 4 |a human 
650 0 4 |a Humans 
650 0 4 |a Hypoglycemic Agents 
650 0 4 |a insulin 
650 0 4 |a Insulin 
650 0 4 |a Intensive insulin therapy 
650 0 4 |a microvasculature 
650 0 4 |a Microvessels 
650 0 4 |a non insulin dependent diabetes mellitus 
650 0 4 |a optical coherence tomography 
650 0 4 |a Optical coherence tomography angiography 
650 0 4 |a procedures 
650 0 4 |a retina blood vessel 
650 0 4 |a Retinal microvasculature 
650 0 4 |a Retinal Vessels 
650 0 4 |a Tomography, Optical Coherence 
700 1 |a Li, M.-X.  |e author 
700 1 |a Peng, X.-Y.  |e author 
700 1 |a Yang, N.  |e author 
773 |t BMC Ophthalmology