Abstract
Insulin treatment has been associated with a paradoxical worsening of diabetes retinopathy since many years in European cohorts. Recently, this issue has been stressed by some studies conducted in other parts of the world. However, the mechanism underlying such evolution is not well understood. An osmotic theory has been evocated but failed to explain the clinical features of the disease. Considering recent findings from basic and clinical research, we discuss the possibility of a synergistic hypothesis based on the simultaneous action of insulin and vascular endothelial growth factor on eye blood vessels. We postulate that exogenous insulin could act synergistically with the vascular endothelial growth factor expressed by ischemic retina so as to trigger vascular proliferation and the worsening of diabetes retinopathy.
Highlights
Diabetes mellitus is a chronic disease associated with significant morbidity and mortality owing to its multiple micro and macrovascular complications [1, 2]
Insulin use and early worsening of diabetes retinopathy: Paradoxical report with growing evidence It is established that diabetic retinopathy and related complications are strongly associated with the presence of chronic hyperglycemia, and results of almost all randomized trials are consistent with the fact that early and intensive glycemic control reduce both the onset and the progression of this condition [13,14,15,16,17,18,19,20]
A synergistic hypothesis could explained both the mechanism and clinical features of early worsening of diabetes retinopathy Previous reports on the increased incidence and worsening diabetic retinopathy with insulin compared with oral anti-diabetic agents have led to the hypothesis that insulin is probably related to the occurrence of this paradoxical early worsening in diabetic retinopathy with rapid lowering of blood pressure
Summary
Diabetes mellitus is a chronic disease associated with significant morbidity and mortality owing to its multiple micro and macrovascular complications [1, 2]. Insulin use and early worsening of diabetes retinopathy: Paradoxical report with growing evidence It is established that diabetic retinopathy and related complications are strongly associated with the presence of chronic hyperglycemia, and results of almost all randomized trials are consistent with the fact that early and intensive glycemic control reduce both the onset and the progression of this condition [13,14,15,16,17,18,19,20]. Tight glycemic control with insulin is associated with recurrent hypoglycemic episodes, and the risk of early worsening of diabetic retinopathy.
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