Nephropathy is delayed by intensified insulin treatment in patients with insulin-dependent diabetes mellitus and retinopathy.
Patients with insulin-dependent diabetes mellitus (IDDM) and non-proliferative retinopathy were randomized to intensified conventional insulin treatment (ICT, n = 44) or regular treatment (RT, n = 51). During a 3-year period the glycosylated haemoglobin (HbA1c) levels were reduced to a greater extent (P = 0.00001) in the ICT group (from 9.5 +/- 0.2 to 7.4%, P = 0.0001) than in the RT group (9.4 +/- 0.2 to 9.0 +/- 0.2, P = 0.004). The urinary albumin excretion rate (UAER) increased significantly (P = 0.033) in the RT group but not in the ICT group, and the UAER differed significantly (P = 0.031) between the groups after 3 years. The mean HbA1c values during the study period independently influenced the deterioration of UAER levels (P = 0.029). Initial diastolic blood pressure (P = 0.112), the HbA1c value at entry (P = 0.480) and the smoking habits (P = 0.959) were not related to change of UAER levels. Manifest nephropathy after 3 years was seen almost exclusively in patients with HbA1c levels above 9%. Improved blood glucose control, without 'near normoglycaemia', delayed the progression of nephropathy in patients with IDDM and retinopathy.
Reichard
P
P
Department of Internal Medicine II, Southern Hospital, Stockholm, Sweden.
Rosenqvist
U
U
D000328:Adult; D000419:Albuminuria; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D011897:Random Allocation; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
D001786:Blood Glucose; D007328:Insulin