INS and diabetic retinopathy: PURPOSE: To critically evaluate evidence supporting the angiogenesis-inflammation hypothesis in diabetic retinopathy (DR); to examine the roles of angiogenic growth factors and inflammatory cytokines in the biphasic effects of insulin on DR - early worsening followed by long-term risk reduction; and to explore broader implications of this hypothesis, including potential biphasic effects of semaglutide due to its insulinotropic action and strategies to mitigate the transient DR exacerbation associated with insulin and insulin secretagogues.