Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes
Abstract
36 patients with insulin-dependent diabetes mellitus who had 'Albustix'-negative urine but raised urinary albumin excretion (30 to 300 mg/24 h) were randomly assigned to either remaining on conventional insulin treatment or continuous subcutaneous insulin infusion and followed up for 2 years. The insulin-infusion group showed a significant, sustained improvement in metabolic control, with a median glycosylated haemoglobin of 7.2% (range 5.9-8.8), but there was no change in the conventional-treatment group (median 8.6%, range 7.2-13.4) (p less than 0.001). Clinical diabetic nephropathy (a urinary albumin excretion rate above 300 mg/24 h in at least two of three 24 h urine collections) developed in 5 patients in the conventional-treatment group, but not in the insulin-infusion group (p less than 0.05, two-tailed). Fractional albumin clearance (mean and range X 10(7] increased in the conventional-treatment group from 160 (35-468) to 360 (29-1580) and was unchanged in the insulin-infusion group (170 [31-608] before to 160 [26-460] after) (p less than 0.05). Insulin infusion had an overall beneficial effect on the annual increase in urinary albumin excretion (p less than 0.05), and the mean glycosylated haemoglobin values correlated positively with annual change in albumin excretion (r = 0.57, p less than 0.0001). The diastolic blood pressure rose significantly in the conventional-treatment group (p less than 0.001), and annual change in mean blood pressure correlated with change…
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In clinical trials, targeting lower HbA1c levels has reduced the rates of chronic diabetes complications in patients with T1D or T2D.
“Moreover, in clinical trials, targeting lower HbA1c levels has reduced the rates of chronic diabetes complications in patients with T1D 190,232 -238 or T2D. 239 -246”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [235]
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- Authors
- Feldt-Rasmussen, B., Mathiesen, E., & Deckert, T.
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1986-12
- Volume
- 328
- Issue
- 8519
- Pages
- 1300-1304
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2088865109
- Cited by
- 447
- References
- 0
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 2 · 2020: 4 · 2019: 2 · 2018: 1 · 2017: 2 · 2015: 3 · 2014: 8 · 2013: 5 · 2012: 2
- FWCI
- 34.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 1 diabetes, diabetic nephropathy, metabolic control, insulin pump therapy, insulin therapy, urinary albumin excretion, glycosylated haemoglobin, blood pressure, disease progression
- MeSH terms
- Adolescent, Adult, Albuminuria, Blood Glucose, Clinical Trials as Topic, Diabetes Mellitus, Type 1, Diabetic Nephropathies, Follow-Up Studies, Glycated Hemoglobin, Humans, Infusions, Parenteral, Insulin, Insulin Infusion Systems, Middle Aged, Random Allocation
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