Diabetic retinopathy regression was more frequent than progression particularly for patients initially with very mild NPDR, and lower HbA1c levels were associated with greater odds of regression in both very mild and mild NPDR.
DR regression occurred in nearly half of patients with very mild NPDR and over one-third of patients with mild NPDR within 3 years.
DR progression was less common than regression, particularly among patients with very mild NPDR at baseline.
Lower HbA1c levels were associated with greater odds of DR regression in patients with either very mild or mild NPDR at baseline.
Insulin use was associated with lower odds of DR regression in multivariable analyses.
Shorter diabetes duration was associated with greater odds of DR regression only among patients with very mild NPDR at baseline.
The study population was drawn from the Indian Health Service teleophthalmology program and had a mean age of 56 years with a majority female composition.
This research suggests that early-stage diabetic retinopathy — damage to the blood vessels in the eye caused by diabetes — can actually improve or reverse over time, and this happens more often than it worsens. Among American Indian patients enrolled in a teleophthalmology screening program, nearly half of those with the earliest (very mild) stage of diabetic eye disease showed regression to a healthier state within three years, and about one-third of those with mild disease also regressed. This is notable because regression of diabetic retinopathy is rarely highlighted in clinical practice. The study also found that better blood sugar control, as measured by lower HbA1c levels, was linked to a higher likelihood of retinopathy improving. Patients who were already on insulin were less likely to see regression, which likely reflects that these patients tend to have more severe or difficult-to-control diabetes to begin with. For those with the very earliest stage of eye disease, having a shorter duration of diabetes was also linked to better chances of regression. These findings matter because they suggest that early detection and active management of blood sugar — through lifestyle changes like increased physical activity and weight loss — may not only slow the worsening of diabetic eye disease but could actually help reverse it, especially when caught early. This supports the value of teleophthalmology screening programs for identifying patients at the earliest stages, when intervention may be most effective.
Bursell S, Fonda S, Borik K, Stainback J, Shahon D. (2026). Rates of nonproliferative diabetic retinopathy (NPDR) regression among patients with very mild or mild NPDR in an Indian Health Service teleophthalmology program, 2015 - 2020.. PloS one. https://doi.org/10.1371/journal.pone.0361052