Retinal Microvasculopathy with Different Insulin Infusion Therapies in Children with Type 1 Diabetes Mellitus without Clinical Diabetic Retinopathy.

Abstract

Purpose: To explore the characteristics and associated factors of retinal microvasculopathy and neurodegeneration with different insulin therapies in children with type 1 diabetes mellitus (T1DM) children without diabetic retinopathy (DR). Methods: 41 T1DM children with multiple daily insulin injections (MDI), 22 T1DM children with continuous subcutaneous insulin infusion (CSII), and 62 age-matched normal controls were enrolled. SPECTRALIS OCT was used to scan 6 *6 mm square area of posterior retina. Results: The Vessel density (VD) of superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) in T1DM -MDI group were all significantly lower than those in the T1DM-CSII and control group (0.39±0.05 vs.0.44±0.04 and 0.42±0.06, p<0.001;0.26±0.04 vs. 0.30±0.02 and 0.28±0.04, p=0.003; 0.30±0.04 vs.0.33±0.04 and 0.32±0.04, p=0.027). In T1DM -MDI group, lower VD of SVP was associated with higher Hemoglobin A1c(HbA1c) (r=-0.377, p=0.015). Foveal avascular zone morphology index (FAZM) in T1DM -MDI and T1DM-CSII group were smaller than control group (0.63±0.11 and 0.63±0.12 vs.0.69±0.15, p=0.040). There was no statistically significant difference in the thickness of the retina among three groups(p>0.05). Conclusion: The VD of posterior retina was lower in T1DM with MDI than healthy controls and associated with higher HbA1c. There was significantly difference on VD betweenT1DM -MDI and T1DM-CSII, with the similar HbA1c. This study suggested that optical coherence tomography angiography (OCTA) could be beneficial for detection of retinal abnormalities in early T1DM children and CSII may be a better choice for T1DM children to prevent the retinal complication than MDI.