Rapid glycemic improvement has raised concern regarding early worsening of diabetic retinopathy (EWDR), particularly in people with poorly controlled type 1 diabetes mellitus (T1DM). A retrospective observational study published in Journal of Diabetes Science and Technology evaluated retinal outcomes following initiation of automated insulin delivery (AID) in adolescents and young adults with T1DM and elevated baseline HbA1c levels.
The study included 95 adolescents and young adults aged 10–30 years with T1DM and baseline HbA1c ≥8.5% before AID initiation. Clinical data, continuous glucose monitoring (CGM) metrics, and retinopathy grading were collected before and after at least 3 months of AID use.
Findings
- Mean HbA1c improved by 2.1 percentage points (22.6 mmol/mol) following AID initiation.
- Diabetic retinopathy remained stable or improved in 72 of 95 participants (75.8%).
- Early worsening of diabetic retinopathy, including diabetic macular edema (DME), occurred in 23 participants (24.2%).
- No participants required treatment for DME.
- Proliferative diabetic retinopathy requiring treatment developed in 3 participants (3.2%), all of whom had preexisting retinopathy and at least one additional diabetes-related complication or risk factor.
- Logistic regression identified age older than 18 years and preexisting diabetic retinopathy at AID initiation as significant risk factors for EWDR.
The analysis found that AID was associated with substantial glycemic improvement while diabetic retinal disease remained stable or improved in most adolescents and young adults with T1DM.
