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Author Spotlight: Understanding Retinal Vessel Resilience and Disease Progression
Published on: January 12, 2024
RETINAL MICROVASCULOPATHY WITH DIFFERENT INSULIN INFUSION THERAPIES IN CHILDREN WITH TYPE 1 DIABETES MELLITUS WITHOUT
Yan Guo1, Xiaoquan Zheng2, Hongwu He1
1Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; and.
Insights
Retinal microvasculopathy is more common in children with type 1 diabetes mellitus on multiple daily injections (MDI) compared to continuous subcutaneous insulin infusion (CSII). Lower vessel density in MDI patients correlates with higher hemoglobin A1c, suggesting CSII may better prevent retinal complications.
Area of Science:
- Ophthalmology
- Endocrinology
- Diabetology
Background:
- Type 1 diabetes mellitus (T1DM) can lead to microvascular complications affecting the retina.
- Early detection of retinal changes is crucial for preventing vision loss.
- Different insulin delivery methods may influence the development of diabetic microvasculopathy.
Purpose of the Study:
- To investigate retinal microvasculopathy and neurodegeneration in children with T1DM using different insulin therapies.
- To identify factors associated with these retinal changes in T1DM patients without retinopathy.
Main Methods:
- Employed SPECTRALIS Optical Coherence Tomography to analyze posterior retinal microvasculature in T1DM patients on multiple daily insulin injections (MDI) and continuous subcutaneous insulin infusion (CSII), alongside healthy controls.
- Assessed vessel density of superficial, intermediate, and deep capillary plexuses, and foveal avascular zone morphology.
Main Results:
- Children with T1DM on MDI exhibited significantly lower vessel density in all retinal plexuses compared to CSII and control groups.
- Lower superficial vascular plexus density in the MDI group was associated with higher hemoglobin A1c levels.
- Foveal avascular zone morphology was reduced in both T1DM groups compared to controls, with no significant difference between MDI and CSII.
Conclusions:
- Optical coherence tomography angiography is valuable for detecting early retinal abnormalities in pediatric T1DM.
- Continuous subcutaneous insulin infusion may be a preferable insulin therapy over multiple daily injections for mitigating retinal complications in T1DM.
Purpose:
To explore the characteristics and associated factors of retinal microvasculopathy and neurodegeneration with different insulin therapies in children with type 1 diabetes mellitus (T1DM) but without diabetic retinopathy.
Methods:
Forty-one children with T1DM with multiple daily insulin injections (MDI), 22 children with T1DM with continuous subcutaneous insulin infusion, and 62 age-matched normal control children were enrolled. SPECTRALIS Optical coherence tomography was used to scan 6×6 mm square area of posterior retina.
Results:
The vessel density of superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus in T1DM-MDI group were all significantly lower than those in the T1DM-CSII and control groups (0.39 ± 0.05 vs. 0.44 ± 0.04 and 0.42 ± 0.06, P < 0.001; 0.26 ± 0.04 vs. 0.30 ± 0.02 and 0.28 ± 0.04, P = 0.003; 0.30 ± 0.04 vs. 0.33 ± 0.04 and 0.32 ± 0.04, P = 0.027). In T1DM-MDI group, lower vessel density of superficial vascular plexus was associated with higher hemoglobin A1c (r = -0.377, P = 0.015). Foveal avascular zone morphology index in T1DM-MDI and T1DM-CSII groups were smaller than that in the control group (0.63 ± 0.11 and 0.63 ± 0.12 vs. 0.69 ± 0.15, P = 0.040). There was no statistically significant difference in the thickness of the retina among the three groups ( P > 0.05).
Conclusion:
The vessel density of posterior retina was lower in children with T1DM with MDI than in healthy control children and associated with higher hemoglobin A1c. There was a significant difference on vessel density betweenT1DM-MDI and T1DM-CSII, with the similar hemoglobin A1c. This study suggested that optical coherence tomography angiography could be beneficial for the detection of retinal abnormalities in children with early T1DM, and continuous subcutaneous insulin infusion may be a better choice than MDI for children with T1DM to prevent the retinal complication.
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