Good glycemic control may not thwart onset of diabetic retinopathy

Patients with type 1 diabetes and excellent glycemic control are still at risk for quickly developing retinopathy, according to a case study.

Jill Hamilton, MD, FRCPC, and colleagues at the University of Toronto described the case of a 16-year-old girl with type 1 diabetes who presented with a 2-week history of fatigue and a 3-year history of intermittent nocturia, polyuria and polydipsia, but no weight loss. A fundus examination was normal. She was started on a twice-daily insulin regimen of split/mixed human neutral protamine Hagedorn and regular insulin before breakfast and supper.

One year after diagnosis, she complained of blurred vision; a funduscopic exam revealed proliferative diabetic retinopathy of the right eye with flame and blot hemorrhages and neovascularization of the disc. Her left eye also showed proliferative retinopathy. She underwent panretinal photocoagulation of the right eye; 6 months later, her left eye progressed to proliferative retinopathy with neovascularization for which she received photocoagulation.

She is currently 25 years old; the retinopathy has remained stable.

The case report is published in the February issue of The Journal of Pediatrics.