Early Worsening of Diabetic Retinopathy Following Initiation of Hybrid Closed-Loop/Automated Insulin Delivery Systems in Type 1 Diabetes: A Systematic Review and Structured Study-Level Synthesis.
Matthew Anson, Ahmed Iqbal, Shazli Azmi et al.
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In 30 seconds
This systematic review evaluated the incidence of early worsening of diabetic retinopathy (EWDR) following the initiation of hybrid closed-loop insulin delivery systems in individuals with type 1 diabetes. Eight observational studies involving 1487 participants were analyzed. EWDR rates within 12 months of HCL initiation ranged from 8.9% to 26.5%, while longer follow-ups showed lower rates, suggesting background progression rather than true early worsening.
Key findings
- EWDR rates within 12 months of HCL initiation ranged from 8.9% to 26.5%.
- Lower EWDR rates of 6.7% at 24 months and 6.1% over a mean follow-up of 4.9 years were observed.
- Study-specific risk ratios for EWDR in comparative studies ranged from 0.32 to 1.51.
Why it matters
Understanding the potential for early worsening of diabetic retinopathy in patients starting hybrid closed-loop insulin systems is crucial for clinicians managing type 1 diabetes, as it may influence monitoring and treatment strategies.
What to keep in mind
The evidence is primarily from retrospective studies with variable retinal assessment timing and inconsistent definitions of EWDR.