title: Development, worsening, and improvement of diabetic microangiopathy in older people: six-year prospective study of patients under intensive diabetes control.
abstract: OBJECTIVE
  To examine retinopathy and nephropathy in elderly patients with diabetes mellitus (DM) under intensive multifactorial DM control.
  
  
  METHODS
  Six-year interventional observation study.
  
  
  METHODS
  Multicenter study including four hospitals.
  
  
  METHODS
  Four hundred thirteen elderly (> or = 65) patients with type 2 DM attending each hospital for 1 year or longer; those receiving hemodialysis or with uncured malignancy were excluded.
  
  
  METHODS
  Development, worsening, and improvement of retinopathy and nephropathy and respective risk factors.
  
  
  RESULTS
  The mean baseline hemoglobin (HbA1c), blood pressure (BP), and total cholesterol were 6.8%, 137/74 mmHg, and 5.13 mmol/L, respectively. Retinopathy developed in 45 of 168 (27%) patients and, of 63 with nonproliferative retinopathy, worsened and improved in 11 (17%) and 23 (37%), respectively. Nephropathy developed in 53 of 227 (23%) patients and improved in 13 of 51 (25%) having it baseline. The mean change in glomerular filtration rate (DeltaGFR, baseline GFR-GFR at the end of the study period) in those with nephropathy at baseline was 21.5 mL/min. HbA1c was related to development of retinopathy (P=.001, odds ratio (OR)=1.91), and serum creatinine (P=.03, OR=1.02), systolic BP (SBP) (P=.03, OR=1.22), and prior stroke (P=.005, OR=3.21) were related to development of nephropathy. In patients with nephropathy at baseline, SBP (P=.03, Spearman's rho (rho)=0.310), total cholesterol (P=.01, rho=0.361), and low-density lipoprotein cholesterol (P=.03, rho=0.322) were correlated with DeltaGFR.
  
  
  CONCLUSIONS
  In elderly patients under intensive control for DM, the outcome of microangiopathy is favorable. Modifiable risk factors were hyperglycemia for development of retinopathy and hypertension and hypercholesterolemia for development or worsening of nephropathy; prior stroke was an unmodifiable risk factor for development of nephropathy.
authors.affiliation: Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Katakura
authors.forename: Motoji
authors.initials: M
authors.lastname: Naka
authors.forename: Teruki
authors.initials: T
authors.lastname: Kondo
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Komatsu
authors.forename: Keishi
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hashizume
authors.forename: Toru
authors.initials: T
authors.lastname: Aizawa
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2; D003928:Diabetic Nephropathies / Q000097:blood / Q000145:classification* / Q000188:drug therapy; D003930:Diabetic Retinopathy / Q000097:blood / Q000145:classification* / Q000188:drug therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D007004:Hypoglycemic Agents