INS and diabetes mellitus: The identified risk factors for EWDR were long duration of diabetes, DR severity before IT, and high initial HbA1c levels which reflects poor glycemic control.[11] In addition, the magnitude of HbA1c reduction was reported to be associated with DR deterioration.[11] In our case, after rapid improvement of blood glucose (with HbA1c reduction 3.7%), a severer aggravation of DR in the patient with initial high-risk PDR was observed on the second month of insulin IT.