The effect of metabolic control on rate of decline in renal function in insulin-dependent diabetes mellitus with overt diabetic nephropathy

Strict glycaemic control has been shown to reduce the risk of developing diabetic nephropathy. In established nephropathy, however, the impact of glycaemic control on prognosis is less clear. Therefore we investigated the effect of long-term glycaemic control on the decline in renal function in insu...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 1998-03, Vol.13 (3), p.651-655
Main Authors: MULEC, H, BLOHME, G, GRÄNDE, B, BJÖRCK, S
Format: Article
Language:English
Subjects:
Adult
Associated diseases and complications
Biological and medical sciences
Blood Glucose - metabolism
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - metabolism
Diabetes Mellitus, Type 1 - physiopathology
Diabetes. Impaired glucose tolerance
Diabetic Nephropathies - physiopathology
Disease Progression
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Follow-Up Studies
Glomerular Filtration Rate
Humans
Kidney - physiopathology
Medical sciences
Prognosis
Retrospective Studies
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BLOHME, G
GRÄNDE, B
BJÖRCK, S
description Strict glycaemic control has been shown to reduce the risk of developing diabetic nephropathy. In established nephropathy, however, the impact of glycaemic control on prognosis is less clear. Therefore we investigated the effect of long-term glycaemic control on the decline in renal function in insulin-dependent diabetic patients with overt nephropathy. The study was performed at two hospital-based diabetes centres in western Sweden. The study was an observational retrospective follow-up study in 158 insulin-dependent diabetics with proteinuria with a mean (+/-SD) age of 36+/-9 years and a diabetes duration of 22+/-8 years. The change in glomerular filtration rate was measured as 51Cr EDTA clearance for a median of 8 years (range 1-17). Glycaemic control was determined with measurements of glycated haemoglobin A1c. The decline in glomerular filtration rate was 3.8+/-3.7 ml/min/year. The blood pressure was 143/82+/-15/7 mmHg and the mean glycated haemoglobin was 8.7+/-1.6%. The correlation coefficient between glycated haemoglobin and decline in glomerular filtration rate was -0.39 (P
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The correlation coefficient between glycated haemoglobin and decline in glomerular filtration rate was -0.39 (P&lt;0.0001 ) and between decline in glomerular filtration rate and systolic and diastolic blood pressure -0.17 (P=0.03) and -0.29 (P=0.003) respectively. In patients with glycated haemoglobin &lt;8.0% and diastolic blood pressure &lt;85 mmHg the decline in glomerular filtration rate was 1.7+/-2.3 ml/min/year. In this retrospective observational study, effective blood-pressure control was associated with a low rate of decline in renal function and a low urinary albumin excretion. 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Impaired glucose tolerance</topic><topic>Diabetic Nephropathies - physiopathology</topic><topic>Disease Progression</topic><topic>Endocrine pancreas. 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1460-2385
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source Oxford Journals Online
subjects Adult
Associated diseases and complications
Biological and medical sciences
Blood Glucose - metabolism
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - metabolism
Diabetes Mellitus, Type 1 - physiopathology
Diabetes. Impaired glucose tolerance
Diabetic Nephropathies - physiopathology
Disease Progression
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Follow-Up Studies
Glomerular Filtration Rate
Humans
Kidney - physiopathology
Medical sciences
Prognosis
Retrospective Studies
title The effect of metabolic control on rate of decline in renal function in insulin-dependent diabetes mellitus with overt diabetic nephropathy
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