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. 1998 Jul;82(7):725–730. doi: 10.1136/bjo.82.7.725

Evidence that upregulation of serum IGF-1 concentration can trigger acceleration of diabetic retinopathy

E Chantelau 1
PMCID: PMC1722687  PMID: 9924360

Abstract

BACKGROUND—Acute reduction of chronic hyperglycaemia can accelerate early diabetic retinopathy. In adolescent patients with Mauriac's syndrome, this phenomenon is related to an upregulation of subnormal serum IGF-1 levels.
AIM—To obtain longitudinal data on serum IGF-1 and retinopathy status in poorly controlled adult insulin dependent (type 1) diabetic patients without Mauriac's syndrome, in whom hyperglycaemia is reduced by intensive insulin therapy.
METHODS—Four patients with chronic severe insulin deficiency and early microangiopathy were studied prospectively. Changes in plasma glucose, HbA1c, serum IGF-1 levels, proteinuria, retinopathy, and clinical status were followed up closely.
RESULTS—Reducing hyperglycaemia from >16 mmol/l (equivalent to HbA1c >11%) to <10 mmol/l (HbA1c <8%) within 5 months increased serum IGF-1 levels by 70-220%. While proteinuria and symptomatic neuropathy regressed, retinopathy progressed from the mild to the severe non-proliferative stage with maculopathy (n=4), and to the proliferative stage (n=1). Laser coagulation was commenced upon the appearance of sight threatening macular oedema (n=4).
CONCLUSION—Upregulation of serum IGF-1 preceding retinal deterioration in these patients suggests a cause-effect relation, consistent with earlier experimental and clinical data. 

 Keywords: diabetes mellitus; macular oedema; metabolic control; intensive therapy; glycated haemoglobin A1c; growth factors

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Figure 1  .

Figure 1  

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Fundus photograph of the right eye of patient CH. Start of improved diabetes control. Retinopathy level 1 (minimal non-proliferative retinopathy9); serum IGF-1 concentration 167 ng/ml.

Figure 2  .

Figure 2  

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Fundus photograph of the right eye of patient CH 1 month after improving diabetes control. Retinopathy level 1, serum IGF-1 concentration 282 ng/ml.

Figure 3  .

Figure 3  

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Fundus photograph of the right eye of patient CH 5 months after improving diabetes control. Retinopathy level 2 (moderate non-proliferative retinopathy9); serum IGF-1 level 284 ng/ml.

Figure 4  .

Figure 4  

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Fundus photograph of the right eye of patient CH 9 months after improving diabetes control. Retinopathy level 5 (proliferative retinopathy9); serum IGF-1 level 307 ng/ml.

Figure 5  .

Figure 5  

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Fluorescein angiogram of the same eye as in Figure 3, before laser coagulation treatment.

Figure 6  .

Figure 6  

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Fluorescein angiogram of the same eye as in Figure 4, showing new vessel on the disc.

Figure 7  .

Figure 7  

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Dynamics of retinopathy level9 (A), serum IGF-1 (B), HbA1c (C), before and after initiation of improved diabetes control (time 0) in four type 1 diabetic patients (CH, SK, JA, CO).

Selected References

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