Evidence mapPaperPMID 30226298Full record

ReviewDiabetes, obesity & metabolism2019

Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review.

Stephen C Bain, Michael A Klufas, Allen Ho, David R Matthews

Registry-linked trialOpen access · hybridAbstract readReview
In one paragraph

Review in Diabetes, obesity & metabolism, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07723820 (Glycemic Velocity as a Modifiable Determinant of Early Retinal Microvascular and Choroidal Change During Initiation of GLP-1 Receptor Agonist Versus SGLT2 Inhibitor Therapy in Type 2 Diabetes), which is not on this map. Cited by 137 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
137citing papers in PubMed, 6 pooled it
9.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07723820 not yet recruitingstarted 2026, after this paper: background citation

Glycemic Velocity as a Modifiable Determinant of Early Retinal Microvascular and Choroidal Change During Initiation of GLP-1 Receptor Agonist Versus SGLT2 Inhibitor Therapy in Type 2 Diabetes: A Prospective Multimodal Retinal Imaging Cohort Study (the GLIDE Study)

Ran2026Enrolled126Registered outcomes9Posted comparisons0ConditionsDiabetic Retinopathy (DR), Type 2 Diabetes MellitusArmsGLP-1 Receptor Agonists, SGLT2 inhibitor
Open the trial in the graph
3 · Its place in the literature

Who cites it

137 citing papers in PubMed, 6 syntheses or guidelines pooled it, 278 citations in OpenAlex.

  1. Pooled it
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  4. Impact of Islet Transplantation on Type 1 Diabetes-Related Complication: A Systematic Review.Transplant international : official journal of the European Society for Organ Transplantation · 2025
    Pooled it
  5. Pooled it
  6. HbADiabetes care · 2021
    Pooled it
  7. Trial
  8. Article
  9. Real-World Glucometric Outcomes of the MiniMed 780G Advanced Hybrid Closed-Loop System in Users with Type 1 Diabetes in Spain.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2026
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77 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Stephen C BainSchool of Medicine, Swansea University, Swansea, UK.ORCID 0000-0001-8519-4964
Michael A KlufasWills Eye Hospital/Mid Atlantic Retina, Philadelphia, Pennsylvania.
Allen HoWills Eye Hospital/Mid Atlantic Retina, Philadelphia, Pennsylvania.
David R MatthewsOxford Centre for Diabetes, Endocrinology and Metabolism, and Harris Manchester College, University of Oxford, Oxford, UK.
Wills Eye Hospital · USSwansea University · GBUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Worsening of diabetic retinopathy (DR) is associated with the initiation of effective treatment of glycaemia in some patients with diabetes. It has been associated with risk factors such as poor blood-glucose control and hypertension, and it manifests prior to the long-term benefits of optimizing glycaemic control. The majority of evidence supports an association of large and rapid reductions in blood-glucose levels with early worsening of DR. Despite a general awareness of early worsening within the diabetes community, mechanisms to explain the phenomenon remain speculative. We provide an overview of early worsening of DR and its pathophysiology based on current data. We describe the phenomenon in various settings, including in patients receiving insulin- or non-insulin-based treatments, in those undergoing bariatric surgery, and in pregnant women. We discuss various mechanisms and theories that have been suggested to explain this paradoxical phenomenon, and we summarize the implications of these in clinical practice.

Indexed as

Blood GlucoseDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic RetinopathyDisease ProgressionFemaleGlycated HemoglobinHumansInsulinPregnancyBlood GlucoseGlycated HemoglobinInsulindiabetic retinopathyGLP-1 analogueglycaemic controlinsulin therapytype 1 diabetestype 2 diabetes

Identifiers

PMID30226298
PMCPMC6587545
OpenAlexW2891332575

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.