NEJM article on Retinopathy Screening interval in Type 1s

Interesting article, showing that for Type 1’s with no evidence of retinopathy, extending your eye screenings may be a reasonable solution.

Also interesting, they defined control as having an A1C in the 6% range, and out of control in the 10% range.


there’s a huge gap between 6% and 10%!

That is very true, but I found it interesting that they chose a more modern definition of tight control, as opposed to a the more standard 7 or below.

well i’m guessing they’re looking at the risk rates. Retinopathy is incredibly prevalent for T1Ds; I would assume that most get it eventually, and that even “tight” control doesn’t prevent it if you define tight as 7% or below. You really need to get to the nondiabetic range before it’s an issue if you’re looking at 30-year prevalence rates.

I agree with you, all this article is saying to me, is that if you are in tight control, your clinically actionable retinopathy progression will be slow enough that you can feel ok in spacing out your dilated eye exams.

I’m in the 6% range, have no evidence of retinopathy or macular edema, and I’ll keep having my dilated retinal exams every six months, thank you.

Interesting bit in Dr. Najeeb’s insulin lecture number 4 about the microvascular risks such as retinopathy being elevated as a function of low c-peptide alone in t1d, even assuming perfect bg management

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I do remember that. Saw this and wonder if there has been any progress since then:

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Well, looks like one of the main companies testing the idea of using c-peptide as treatment folded its tent up after a phase 2b trial failed:

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Well, that is interesting. Really, they got off pretty inexpensively and quickly. They only had to raise $48 million dollars and got an answer showing their treatment, while a promising idea, was not helpful in patients.

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