Impact of initial treatment on renal function in newly-diagnosed type 2 (non-insulin-dependent) diabetes mellitus.
The impact of improved glycaemic control on renal function in newly-presenting Type 2 (non-insulin-dependent) diabetic patients has not been adequately researched. Consequently, glomerular filtration rate and effective renal plasma flow and urinary albumin excretion rates were determined in 76 subjects (age (mean (SD)): 54 (9.5) years; 50 male) of an original cohort of 110 newly-presenting normotensive non-proteinuric Type 2 diabetic patients following 6 months treatment with diet alone (n = 42) or with oral hypoglycaemic agents (n = 34). Significant reductions were observed in (presentation vs 6 months): body mass index (p < 0.001); fasting plasma glucose (p < 0.001); glycated haemoglobin (HbA1) (p < 0.001); systolic blood pressure (p < 0.01); and diastolic blood pressure (p < 0.001). Glomerular filtration rate declined from 117 (22) to 112 (21) ml.min-1 (p < 0.01), with unchanged effective renal plasma flow (534 (123) vs 523 (113) ml.min-1) and filtration fraction (22.4 (3.0) vs 21.8 (3.4)%). Albumin excretion rate (median (range)) declined from 1.1 (0.1-34.7) to 0.5 (0.1-29.9) micrograms.min-1 (p < 0.01). Changes in glomerular filtration rate (delta values) were inversely correlated with presentation values (p < 0.001), and positive relationships were observed with delta effective renal plasma flow (p < 0.01), and delta glycated haemoglobin (p < 0.05). Type 2 diabetic patients with glomerular filtration rate values at presentation over 120 ml.min-1 demonstrated significant reduction in glomerular filtration rate (n = 31; p < 0.001), whilst those with original values less than 120 ml.min-1 remained unchanged (n = 45).(ABSTRACT TRUNCATED AT 250 WORDS)
Vora
J P
JP
Department of Medicine, University of Wales College of Medicine, Cardiff, UK.
Dolben
J
J
Williams
J D
JD
Peters
J R
JR
Owens
D R
DR
D000419:Albuminuria; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D003927:Diet, Diabetic; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D014280:Triglycerides