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Intensive therapy reduces incidence, cost of ocular surgery in patients with type 1 diabetes
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Intensive insulin therapy significantly reduced the long-term incidence and cost of ocular surgery in patients with type 1 diabetes, according to an analysis of data from the Diabetes Control and Complications Trial.
The trial included 1,441 patients with a mean age of 27 years with type 1 diabetes; 711 patients were randomized to intensive insulin therapy, and 730 patients were randomized to conventional therapy designed to prevent symptoms of hyperglycemia and hypoglycemia with no specific glucose targets.
Average duration of treatment was 6.5 years; median follow-up was 23 years.
One hundred thirty ocular operations were performed in 63 patients in the intensive therapy group (8.9%) and 189 operations were performed in 98 patients in the conventional therapy group (13.4%); the between-group difference was statistically significant (P < .001).
Adjusted data showed that intensive therapy reduced the risk of any diabetes-related ocular surgery by 48% (P < .001) and the risk of any ocular surgery by 37% (P = .01).
Forty-two patients in the intensive therapy group and 61 in the conventional therapy group underwent cataract extraction. The difference was significant (P = .002).
Twenty-nine patients in the intensive therapy group and 50 in the conventional therapy group underwent vitrectomy, retinal detachment surgery or both. The difference was significant (P = .01).
Nine patients in the intensive therapy group and 14 in the conventional therapy group underwent glaucoma surgery. Two patients in the intensive therapy group and three in the conventional therapy group had corneal surgery. These differences were not significant.
Inflation-adjusted costs in 2010 dollars for all cataract extraction, vitrectomy and glaucoma operations totaled $429,469 in the intensive therapy group and $634,925 in the conventional therapy group, a difference of 32%. - by Matt Hasson
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
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