title: Intraocular pressure and aqueous humor flow during a euglycemic-hyperinsulinemic clamp in patients with type 1 diabetes and microvascular complications.
abstract: BACKGROUND
  Microvascular complications, including retinopathy and nephropathy are seen with type 1 diabetes. It is unknown whether functional changes in aqueous humor flow or intraocular pressure (IOP) develop in parallel with these complications. This study was designed to test the hypothesis that clinical markers of microvascular complications coexist with the alteration in aqueous humor flow and IOP.
  
  
  METHODS
  Ten patients with type 1 diabetes and ten healthy age- and weight-matched controls were studied. Aqueous flow was measured by fluorophotometry during a hyperinsulinemic-euglycemic clamp (insulin 2 mU/kg/min). Intraocular pressure was measured by tonometry at -10, 90 and 240 minutes from the start of the clamp, and outflow facility was measured by tonography at 240 minutes.
  
  
  RESULTS
  During conditions of identical glucose and insulin concentrations, mean aqueous flow was lower by 0.58 microl/min in the diabetes group compared to controls (2.58 +/- 0.65 versus 3.16 +/- 0.66 microl/min, respectively, mean +/- SD, p = 0.07) but statistical significance was not reached. Before the clamp, IOP was higher in the diabetes group (22.6 +/- 3.0 mm Hg) than in the control group (19.3 +/- 1.8 mm Hg, p = 0.01) but at 90 minutes into the clamp, and for the remainder of the study, IOP was reduced in the diabetes group to the level of the control group. Ocular pulse amplitude and outflow facility were not different between groups. Systolic blood pressure was significantly higher in the diabetes group, but diastolic and mean arterial pressures were not different.
  
  
  CONCLUSIONS
  We conclude that compared to healthy participants, patients with type 1 diabetes having microalbuminuria and retinopathy have higher IOPs that are normalized by hyperinsulinemia. During the clamp, a reduction in aqueous flow was not statistically significant.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5840, USA. jtlane1@unmc.edu
authors.forename: James T
authors.initials: JT
authors.lastname: Lane
authors.forename: Luann
authors.initials: L
authors.lastname: Larson
authors.forename: Shan
authors.initials: S
authors.lastname: Fan
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stoner
authors.forename: Eyal
authors.initials: E
authors.lastname: Margalit
authors.forename: Carol B
authors.initials: CB
authors.lastname: Toris
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000503:physiopathology; D001082:Aqueous Humor; D001794:Blood Pressure; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000503:physiopathology; D005123:Eye / Q000098:blood supply; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology*; D007429:Intraocular Pressure; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011674:Pulse; D013997:Time Factors; D055815:Young Adult