Diabetic Retinopathy Progression in T1D: Continuous Insulin Infusion Vs Multiple Daily Injections

Pavankumar Kamat


May 17, 2021


  • In patients with type 1 diabetes (T1D), continuous subcutaneous insulin infusion (CSII) therapy was associated with a lower risk of diabetic retinopathy progression vs multiple daily insulin injections (MDI), without an increased risk of early diabetic retinopathy worsening.

  • Furthermore, a reduction in glycated haemoglobin (HbA1c) level was observed, which was not associated with a reduction in diabetic retinopathy progression.

Why this matters

  • Findings will aid in patient-centred decision-making about insulin treatment choices and diabetic retinopathy screening intervals after treatment changes.

Study design

  • This retrospective cohort study included 415 patients with T1D who initiated CSII therapy (n=204) and MDI therapy (n=211), identified from the Scottish Care Information-Diabetes (SCI-Diabetes) database.

  • Funding: Royal College of Surgeons and Edinburgh and Lothians Health Foundation.

Key results

  • At all follow-up time points, CSII vs MDI group had significantly lower HbA1c levels (P<.001) and a greater reduction in HbA1c level at 1 year (−6 mmoL/moL [−0.6%] vs −1 mmoL/moL [−0.1%]; P<.01).

  • Over a mean follow-up of 2.3 years, diabetic retinopathy progression occurred in 38 (18.6%) participants in the CSII group vs 56 (26.5%) participants in the MDI group (P=.0097).

  • HbA1c level >75 mmoL/moL (>9%) vs <58 mmoL/moL (<7.5%) was associated with diabetic retinopathy progression in the MDI group (P=.0049) but not in the CSII group (P=.93).

  • Change in HbA1c level at 1 year from baseline was not associated with a reduction in diabetic retinopathy progression in both CSII (P=.19) and MDI groups (P=.21).


  • Retrospective design.


Reid LJ, Gibb FW, Colhoun H, Wild SH, Strachan MWJ, Madill K, Dhillon B, Forbes S. Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin. Diabetologia. 2021 May 8 [Epub ahead of print]. doi: 10.1007/s00125-021-05456-w. PMID: 33966091. View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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