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   Table of Contents      
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 477-478

Author's reply

1 Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
2 Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India

Date of Web Publication3-Aug-2016

Correspondence Address:
Viswanathan Mohan
Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, No. 6, Conran Smith Road, Gopalapuram, Chennai - 600 086, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.187694

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How to cite this article:
Rajalakshmi R, Prathiba V, Mohan V. Author's reply. Indian J Ophthalmol 2016;64:477-8

How to cite this URL:
Rajalakshmi R, Prathiba V, Mohan V. Author's reply. Indian J Ophthalmol [serial online] 2016 [cited 2020 Jul 13];64:477-8. Available from: http://www.ijo.in/text.asp?2016/64/6/477/187694


We wish to thank the author for reading our article [1] with interest and for the response. [2] We appreciate the author's contribution to the literature, "Dual effect hypothesis of insulin analogues on diabetic retinopathy."

We agree that studies have shown the role of insulin-like growth factor in the pathogenesis of diabetic retinopathy (DR). [3] However, we wish to mention that though there are a few anecdotal reports that some insulin analogs might worsen retinopathy, it has been proven by a randomized controlled trial that there is no evidence of greater risk of the development or progression of DR with insulin glargine. [4]

Many established studies such as the Diabetes Control and Complications Trial (DCCT) (Type 1 diabetes) [5] and the Steno Study (Type 2 diabetes) [6] have shown that long-term, intensified intervention aimed at multiple risk factors, particularly glycemic control, reduces the risk for microvascular events, including retinopathy by about 50%. In the long-term follow-up of the DCCT, the Epidemiology of Diabetes Interventions and Complications, the finding that even 7 years after conclusion of the treatment of the DCCT, retinopathy progression in the original "intensive" control group (treated with three times insulin) continued to be much slower than that in the "conventional" treatment group indicates the importance of tight glycemic control in the prevention and management.

Regarding the mention in the letter that Gadkari et al. [7] reported insulin usage as a risk factor for DR in the Indian population, we have also reported similar results in our Chennai Urban Rural Epidemiology Study-Eye Study. [8] The possible explanation is that DR is associated with prolonged uncontrolled hyperglycemia and such patients with Type 2 diabetes are more likely to be treated with insulin along with or without oral hypoglycemic agents (OHA) while those who are under better metabolic control are likely to be continued on OHA. Second, diabetic patients with microvascular complications such as retinopathy and nephropathy tend to be preferentially treated by physicians with insulin because of the presence of these complications. Hence, it is likely that insulin treatment is the effect and not the cause of the retinopathy. Obviously, more studies need to be done on this subject.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rajalakshmi R, Prathiba V, Mohan V. Does tight control of systemic factors help in the management ofdiabetic retinopathy? Indian J Ophthalmol 2016;64:62-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Kaya A. Dual effect hypothesis of insulin analogs on diabetic retinopathy. Indian J Ophthalmol 2016;64:476-7.   Back to cited text no. 2
  Medknow Journal  
Poulaki V, Joussen AM, Mitsiades N, Mitsiades CS, Iliaki EF, Adamis AP. Insulin-like growth factor-I plays a pathogenetic role in diabetic retinopathy. Am J Pathol 2004;165:457-69.  Back to cited text no. 3
Rosenstock J, Fonseca V, McGill JB, Riddle M, Hallé JP, Hramiak I, et al. Similar progression of diabetic retinopathy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: A long-term, randomised, open-label study. Diabetologia 2009;52:1778-88.  Back to cited text no. 4
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329:977-86.  Back to cited text no. 5
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003;348:383-93.  Back to cited text no. 6
Gadkari SS, Maskati QB, Nayak BK. Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014. Indian J Ophthalmol 2016;64:38-44.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M. Risk factors for diabetic retinopathy in a South Indian type 2 diabetic population - The Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4. Diabet Med 2008;25:536-42.  Back to cited text no. 8


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