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TOPLINE:

The use of continuous glucose monitoring (CGM) was linked to reduced risk for diabetic retinopathy and proliferative diabetic retinopathy in adults with type 1 diabetes (T1D) in a retrospective cohort study.

METHODOLOGY:

• The study reviewed electronic health records for adults with T1D who were seen at both the Johns Hopkins Endocrine and Diabetes Center and the Wilmer Eye Institute in Baltimore, Maryland, from 2013 to 2021.
• Researchers assessed the association between the use of diabetes technology — CGM, insulin pumps, or both — and retinopathy risk in 550 patients (median age, 40 years; 54.4% women; 68.4% White).
• During the 8-year period, 62.7% of patients used CGM; 58.2% used insulin pumps; and 47.5% used both.
• The primary outcome was the development of proliferative or nonproliferative diabetic retinopathy with or without macular edema.
• The secondary outcome was the progression of diabetic retinopathy in patients with more than one ophthalmology encounter.

TAKEAWAY:

• Overall, 44.4% of patients were diagnosed with diabetic retinopathy; 11.1% and 49.2% had nonproliferative diabetic retinopathy with and without macular edema, respectively, while 11.9% and 27.9% had proliferative diabetic retinopathy with and without macular edema, respectively.
• Patients who used CGM had lower odds of diabetic retinopathy (odds ratio [OR], 0.52; P = .008) and lower odds of proliferative diabetic retinopathy (OR, 0.42; P = .004) than patients who did not use CGM.
• Insulin pump use alone did not show an association with diabetic retinopathy, but CGM and pump use together were associated with lower odds of proliferative diabetic retinopathy (OR, 0.60; P = .03) than no CGM or pump use.
• Among patients with more than one ophthalmology encounter who did not have a proliferative diabetic retinopathy diagnosis at baseline, only 21.8% experienced some progression of diabetic retinopathy.
• Microvascular complications (OR, 5.48; P < .001) and higher mean A1c levels (OR, 1.24; P = .03) were associated with the risk for diabetic retinopathy progression.

IN PRACTICE:

"CGM has a unique advantage that can support the prevention of diabetic retinopathy. This can be particularly beneficial in groups that are at the highest risk for retinal complications," wrote Estelle M. Everett, MD, David Geffen School of Medicine, University of California, Los Angeles, in an invited commentary.

SOURCE:

The investigation, led by Tin Yan Alvin Liu, MD, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, was published along with an invited commentary in JAMA Network Open.

LIMITATIONS:

Results could have been affected by potential bias introduced during the selection of participants to receive CGM. In addition, information on the starting dates for insulin pumps was not available. Most of the participants had private insurance and were White, so the findings may not be generalizable.

DISCLOSURES:

The study was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc. to the University of Wisconsin-Madison Department of Ophthalmology and Visual Sciences and from the National Eye Institute of the National Institutes of Health. One of the authors reported receiving grants outside of the submitted work.