Association of insulin therapy with diabetic retinopathy in type 2 diabetes: A cross-sectional analysis from the Beichen Eye Study

• Insulin therapy (monotherapy or combined with oral agents) is associated with a higher prevalence of diabetic retinopathy in type 2 diabetes. • No significant association was found between glucose-lowering regimens and DR severity. • Based on a community-based Chinese cohort with standardized DR grading. • Highlights the need for targeted screening in insulin-treated diabetic patients. To describe and investigate the associations between different glucose-lowering management and diabetic retinopathy (DR). Our study was a cross-sectional analysis. By comparing different glucose-lowering management methods, we aim to explore their impact on the occurrence of diabetic retinopathy (DR) and their influence on its severity. Logistic regression models were used to estimate the odds ratio (OR). Through the Beichen Eye Study (BCES), 844 patients were included in the cross-sectional analysis. The prevalence of DR was 19.30% among patients on oral hypoglycemic agents (OHA), 50.00% on insulin treatment, and 37.12% among those on combined use, giving an overall frequency of 24.65%. No statistically significant differences were observed among different types of oral hypoglycemic agents on the incidence and severity of DR. Logistic regression showed insulin therapy was associated with the prevalence of DR [insulin: OR= 3.57 (95% CI: 1.16 ∼ 11.05), p= 0.027; combination: OR= 2.01 (95% CI: 1.39 ∼ 2.91), p< 0.001]. Compared with OHA, either increasing insulin therapy or using insulin alone can be a risk factor for DR, yet it has no impact on DR severity.