Worsening of Diabetic Retinopathy Severity Level Associated with Initiation of Tight Glucose Control

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By Neil M. Bressler, MD
Johns Hopkins University
Co-author(s): Voraporn Chaikitmongkol, MD
Uploaded on Feb 11, 2013.
Last modified by Caroline Bozell on Feb 12, 2013.
Reviewed by Caroline Bozell

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Appears in: Miscellaneous
Imaging device: Fundus camera
Description: Tight control of systemic blood sugar in juvenile-onset diabetes may lead to worsen diabetic retinopathy for a temporary period, and will lead to better retinopathy condition in longer term of the disease1. A 20-year-old man with Type 1 diabetes presented with severe non-proliferative diabetic retinopathy in both eyes at the initiation of intensive diabetes treatment (Fig A, C). 3 months after initiating tight blood sugar control, his fundus shows substantial worsening of this diabetic retinopathy severity level with new neovascularization of the disc, numerous new nerve fiber layer infarcts surrounding the optic nerve (in the absence of any systemic hypertension) and a marked increase in intraretinal hemorrhages in both eyes (Fig B, D). Reference: 1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986.