Improvement of blood glucose control in IDDM patients retards the progression of morphological changes in early diabetic nephropathy.
We investigated in a randomized, prospective study the influence of improved blood glucose control during 2-3 years in young insulin-dependent diabetic (IDDM) patients with microalbuminuria, which is indicative of early nephropathy. Patients were randomized either to intensive treatment by continuous subcutaneous insulin infusion (CSII) (n = 9) or CT (n = 9). Kidney biopsies were taken at baseline and after 26-34 months. End points were structural changes in the glomeruli. Sensitive, quantitative, morphometric methods were used. The blood glucose control improved significantly (p = 0.01) during the study in the CSII-group as glycated haemoglobin (HbA1c) fell from 10.1% ([95% CI] 8.9-11.3) to 8.6% (7.9-9.2), but not in the CT-group, 10.1% (8.3-11.9) vs 9.7% (8.7-10.8). Mean HbA1c during the study period was significantly lower in the CSII-group than in the CT-group, 8.7% (8.1-9.3) vs 9.9% (8.5-11.3), p = 0.04. Basement membrane thickness (BMT) increased in both groups, most (CT vs CSII, p = 0.03) in the CT-group: 140 nm (50-230) vs CSII: 56 nm (27-86). In the CT-group only an increase was seen in matrix/mesangial volume fraction (p = 0.006) and matrix star volume (p = 0.04). Furthermore, a positive correlation between mean HbA1c during the study and change from baseline in BMT (r = 0.70, p = 0.001) and matrix/glomerular volume fraction (r = 0.33, p = 0.09, NS) was demonstrated. Albumin excretion rate correlated significantly to BMT and most of the matrix parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
Bangstad
H J
HJ
Aker Diabetes Research Centre, Aker University Hospital, Oslo, Norway.
Osterby
R
R
Dahl-Jørgensen
K
K
Berg
K J
KJ
Hartmann
A
A
Hanssen
K F
KF
D000293:Adolescent; D000328:Adult; D000419:Albuminuria; D001706:Biopsy; D001786:Blood Glucose / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D005919:Glomerular Filtration Rate; D005920:Glomerular Mesangium; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007263:Infusions, Parenteral; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology*; D007678:Kidney Glomerulus / Q000473:pathology
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin