Abstract
Microvascular diabetic complications are the most common causes of morbidity and mortality of patients with type 1 disease. Diabetic nephropathy is becoming the single most common cause of end stage renal failure, while diabetic retinopathy is the most common cause of blindness in working-age population. The main aim of the study was to evaluate the progression of late microvascular complications in type 1 diabetic patients treated by conventional or intensified insulin regimen over the period of 10 years. We selected a random sample of 32 patients, including 14 males and 18 females, aged 30,6 +/- 11,8 years, with average duration of the disease of 4,8 +/- 3,2 years. They did not show signs of overt diabetic nephropathy, while 5 patients had background retinopathy. All the patients had their fasting and postprandial glycaemia, HbAlc, 24/hour proteinuria, blood pressure, height and weight measured and body mass index calculated (BMI). There was a trend towards increasing values of HbAlc (6.9 +/- 0.8 vs. 7.4 +/- 1.0 %, p < 0.05), fasting glycaemia (6.8 +/- 08 vs. 7.8 +/- 1.2 mmol/l, p < 0.05), postprandial glycaemia (9.2 +/- 1.5 vs. 11.3 +/- 1.9 mmol/l, p <0.01), systolic and diastolic blood pressure values (120.0 +/- 10.8 vs. 128.5 +/- 16.8 mmHg, p<0.05; and 73.4 +/- 8.1 vs. 79.8 +/- 9.8 mmHg, p< 0.05) although no hypertensive patient was diagnosed. There were 11 persons (34.4%) with persistent proteinuria of 200 mg/24 hour or more and significant difference in overall proteinuria in 10 yrs period (121.3 +/- 37.3 vs. 312.8 +/- 109.9 mg/24 h, p< 0.001). Overall, 9 persons (28.1%) were diagnosed with simple, background retinopathy, but 6 of them (18.8%) had signs of proliferative form of the disease. The results indicate significant changes in progression of proteinuria in both groups although retinopathic progression was observed but was not significant in the intensively treated group.
Highlights
Seriousness of metabolic disorder in diabetes mellitus is mostly exposed in the form of development of late microvascular and macrovascular complications
The main aim of this study is to evaluate the onset and progression of late microvascular complications in patients with type disease who are treated either conventionally or by intensive insulin regimen, over the period of years
Development of retinopathy was significantly more frequent in the group under conventional insulin regimen (p= . ) (Table ), while significant progression was not noted in the proportion of subjects under intensified insulin regimen (p= . ) (Table )
Summary
Seriousness of metabolic disorder in diabetes mellitus is mostly exposed in the form of development of late microvascular and macrovascular complications. Diabetic nephropathy is becoming the most frequent cause of end-stage renal failure, and currently, in Europe and the USA, - of those requiring renal replacement therapy, dialysis or transplant, suffer from diabetes ( , , ). It is known that, in the developed countries, diabetic retinopathy is the most common cause of blindness in people aged – years ( ). Prevention of onset and progression of these complications is still the most important task in comprehensive treatment of people suffering from diabetes. It requires early detection of incipient microvascular changes as well as their adequate and timely treatment ( , )
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