Impact of Insulin Pump Therapy and Islet Transplantation on Progression of Diabetic Retinopathy in Type 1 Diabetes

Impact of Insulin Pump Therapy and Islet Transplantation on Progression of Diabetic Retinopathy in Type 1 Diabetes

 

Diabetic retinopathy is a clinically well-defined, sight threatening, chronic microvascular complication that eventually affects virtually all people with diabetes. It represents one of the major causes of blindness in the world. Progression of retinopathy is related to hyperglycaemia but it is known that rapid improvement of hyperglycaemia in people with diabetes, may paradoxically lead to a progression of diabetic retinopathy at least in the short term. Therapies associated with improvement in hyperglycaemia include insulin pump therapy and islet transplantation. However the impact of such therapies on the progression of diabetic retinopathy have not been well studied particularly in relation to the stabilisation of their glycaemic control. We aim to examine prospectively a cohort of subjects preceding commencement of insulin pump/islet transplantation at regular intervals for 1 year. Retinal screening along with novel assessments of the retinal vessels using Optical Coherence Tomography Angiography (OCTA) will be performed alongside assessments of metabolic control (HbA1c) and Continuous Glucose Monitoring Systems (CGMS), the latter allowing an assessment of glycaemic lability. The SCI-Diabetes programme will be utilised to retrospectively examine eye disease pre and post commencement of insulin pump therapy in Lothian with an emphasis on changes noted over the first year of therapy.

Such studies will allow robust assessments of the relationship between changes in metabolic control and eye disease, and may inform screening strategies with respect to islet transplantation, therefore leading to improved medical outcomes.  

 

Clinical Research Fellow: Laura Reid

Principal Investigator: Shareen Forbes

Co-Investigators: Bal Dhillon, Karen Madill, Fraser Gibb

Collaborators: Edinburgh Imaging Facilities (Tom MacGillivray), Islet Transplant Programme Scotland, Department of Diabetes, Department of Opthalmology, Scottish Diabetes Research Network Type 1 Bioresource

Funding: Royal College of Surgeons Major Opthalmology Award