Continuous subcutaneous insulin infusion halts prepregnancy DR progression: Study
France: Women having prepregnancy diabetic retinopathy (DR) treated with continuous subcutaneous insulin infusion (CSII) during and before pregnancy had a lower risk of DR progression, according to a recent study in the journal Diabetes Care.
The researchers suggests that women with type 1 diabetes should undergo ophthalmologic examination both before and during pregnancy. Women having severe prepregnancy diabetic retinopathy should be treated before planning pregnancy.
Pregnancy is associated with DR development and progression but DR incidence remains unclear. Julien Bourry, Lille University Hospital, Lille, France, and colleagues assessed the rate of DR progression and its predictors during pregnancies in type 1 diabetes patients.
The researchers reported the retrospective data from pregnancies in patients with type 1 diabetes followed in Lille, France (1997–2015). In cases of severe nonproliferative retinopathy or progression, eye examination was performed every 3 months or every month.
Progression was defined by DR degradation (≥1 stage of the Early Treatment Diabetic Retinopathy Study [ETDRS] classification); it included DR development and worsening in patients without and with prepregnancy DR, respectively.
The study included a total of 499 pregnancies in 375 patients; prepregnancy retinopathy was present in 30.3%.
Key findings of the study include:
- Progression, development, and worsening rates were 21.8%, 24.4% of those without retinopathy, and 15.9% of those with retinopathy, respectively.
- Development of sight-threatening retinopathy was rare. Progression mainly occurred in early or midpregnancy.
- Elevated prepregnancy HbA1c and duration of diabetes ≥10 years were predictors of DR progression. Among pregnancies with prepregnancy DR, continuous subcutaneous insulin infusion (CSII) tended to decrease the risk of DR progression.
- Among CSII-treated patients, those with prepregnancy DR had a significantly decreased risk of DR progression.
- Among the 270 pregnancies of women with any DR during pregnancy who returned for a postpartum ophthalmologic examination, the rate of progression was only 4.1% and the rate of regression was 9.3%.
"This study provides epidemiologic data on progression of retinopathy during pregnancy and will be useful for future guidelines for retinopathy screening," wrote the authors.
The study titled, "Progression of Diabetic Retinopathy and Predictors of Its Development and Progression During Pregnancy in Patients With Type 1 Diabetes: A Report of 499 Pregnancies," is published in the journal Diabetes Care.
DOI: https://care.diabetesjournals.org/content/44/1/181
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