Glycaemia, arterial pressure and micro-albuminuria in Type 1 (insulin-dependent) diabetes mellitus

SummaryPlasma glucose control and arterial pressure were assessed in 28 Type 1 (insulin-dependent) diabetic patients with different degrees of micro-albuminuria. They were divided into two groups according to their urinary albumin excretion rate: a low micro-albuminuria group (n= 16) with albumin excretion ranging between 12.1 and 28.9 μg/min and a high micro-albuminuria group (n= 12) with albumin excretion between 32.4 and 91.3 μg/min. The groups were matched for age, sex and duration of diabetes with the same number of normo-albuminuric (2.0–10.4 μg/min) diabetic control subjects. Both the low and high micro-albuminuria groups had significantly higher glycosylated haemoglobin levels and mean plasma glucose concentrations during a 24-h profile than their respective normo-albuminuric control subjects. A correlation between glycosylated haemoglobin level and urinary albumin excretion rate was found in the whole study group (r= 0.48; p< 0.001). Arterial pressure (both systolic and diastolic) was significantly higher in the high micro-albuminuria group than in either the control group or the low microalbuminuria group. A significant correlation was found between arterial pressure and albumin excretion rate in the whole study population (r= 0.49; p< 0.001) as well as in the pooled micro-albuminuria groups (r= 0.43; p< 0.05). Multiple regression analysis showed that glycosylated haemoglobin and arterial pressure levels were independently correlated with albumin excretion rates. Diabetic patients with micro-albuminuria of any degree have worse glycaemic control than normo-albuminuric patients. Higher levels of arterial pressure, though often sub-hypertensive, are associated with levels of micro-albuminuria predictive of later development of clinical proteinuria. Thus high plasma glucose and high arterial pressure, or both, characterise those diabetic patients at increased risk of nephropathy. These indices of risk are potentially reversible.

[1]  H. Parving,et al.  Increased urinary albumin-excretion rate in benign essential hypertension. , 1974, Lancet.

[2]  M. Steffes,et al.  Diabetic Glomerulopathy Following Unilateral Nephrectomy in the Rat , 1978, Diabetes.

[3]  R. Rasch.  Prevention of diabetic glomerulopathy in streptozotocin diabetic rats by insulin treatment , 1979, Diabetologia.

[4]  Mogensen Ce.  Renal function changes in diabetes. , 1976 .

[5]  R. Bilous,et al.  Proteinuria in diabetes mellitus: role of spontaneous and experimental variation of glycemia. , 1982, Kidney international.

[6]  J. Pickup,et al.  Effect of control of blood glucose on urinary excretion of albumin and beta2 microglobulin in insulin-dependent diabetes. , 1979, The New England journal of medicine.

[7]  J. Baynes,et al.  Enhanced nonenzymatic glucosylation of human serum albumin in diabetes mellitus. , 1979, Proceedings of the National Academy of Sciences of the United States of America.

[8]  B. Brenner,et al.  Glomerular hemodynamics in experimental diabetes mellitus. , 1981, Kidney international.

[9]  R. Bilous,et al.  Correction of Exercise-induced Microalbuminuria in Insulin-dependent Diabetics After 3 Weeks of Subcutaneous Insulin Infusion , 1981, Diabetes.

[10]  J. Brod,et al.  Development of hypertension in renal disease. , 1983, Clinical science.

[11]  M. Steffes,et al.  The kidney in diabetes. , 1981, The American journal of medicine.

[12]  N Veall,et al.  Glomerular filtration rate measurement in man by the single injection methods using 51Cr-EDTA. , 1969, Clinical science.

[13]  H. Keen,et al.  The consomitants of raised blood sugar: studies in newly-detected hyperglycaemics. II. Urinary albumin excretion, blood pressure and their relation to blood sugar levels. , 1969, Guy's Hospital reports.

[14]  H. Keen,et al.  AN IMMUNOASSAY METHOD FOR URINARY ALBUMIN AT LOW CONCENTRATIONS. , 1963, Lancet.

[15]  A. Matas,et al.  Effects of Pancreatic Islet Transplantation on the Increased Urinary Albumin Excretion Rates in Intact and Uninephrectomized Rats with Diabetes Mellitus , 1978, Diabetes.

[16]  W. Kannel,et al.  Predisposition to atherosclerois in the head, heart, and legs , 1973 .

[17]  H. Parving,et al.  Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion. , 1982, Acta endocrinologica.

[18]  H. Parving,et al.  A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy , 1981, Diabetologia.

[19]  M. Cohen,et al.  Nonenzymatic Glycosylation of Basement Membranes: In Vitro Studies , 1981, Diabetes.

[20]  N. Lassen,et al.  The effect of metabolic regulation on microvascular permeability to small and large molecules in short-term juvenile diabetics , 1976, Diabetologia.

[21]  W. Kannel,et al.  Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. , 1972, JAMA.

[22]  J. Syllaba.  [Diabetic nephropathy. A clinical study]. , 1967, Vnitrni lekarstvi.

[23]  E. B. Pedersen,et al.  Effect of antihypertensive treatment on urinary albumin excretion, glomerular filtration rate, and renal plasma flow in patients with essential hypertension. , 1976, Scandinavian journal of clinical and laboratory investigation.

[24]  H. Keen,et al.  MICROALBUMINURIA AS A PREDICTOR OF CLINICAL NEPHROPATHY IN INSULIN-DEPENDENT DIABETES MELLITUS , 1982, The Lancet.

[25]  D. Mackintosh,et al.  Determinants of the Penetration of Proteins Through the Glomerular Barrier in Insulin-dependent Diabetes Mellitus , 1983, Diabetes.

[26]  M. Steffes,et al.  The Effects of Goldblatt Hypertension on Development of the Glomerular Lesions of Diabetes Mellitus in the Rat , 1978, Diabetes.