Development, worsening, and improvement of diabetic microangiopathy in older people: six-year prospective study of patients under intensive diabetes control.
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.
Katakura
Masafumi
M
Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, Japan.
Naka
Motoji
M
Kondo
Teruki
T
Komatsu
Mitsuhisa
M
Yamauchi
Keishi
K
Hashizume
Kiyoshi
K
Aizawa
Toru
T
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
D007004:Hypoglycemic Agents