Near-normotension and near-normoglycemia in blind Type I diabetic patients with overt diabetic nephropathy

Abstract

In patients with diabetic nephropathy, near-normalization of blood pressure (BP) and blood sugar may have a beneficial impact on changes in kidney function, but visually impaired patients may face difficulties when striving for optimal control of hypertension and hyperglycemia. In a prospective feasibility study, we followed a group of nine blind Type I (insulin-dependent) diabetic patients (mean age 30 ± 4 years) with overt diabetic nephropathy and uncontrolled hypertension. All patients received intensified insulin therapy after a structured diabetes treatment and teaching program, and adapted their antihypertensive drug treatment to self-monitored BP values. At recruitment, HbA 1c values were 5.8 ± 0.6%, and remained stable at 6.3 ± 1.7% after a mean observation period of 27 months. BP pressure decreased from 150 ± 14 99 ± 14 mmHg to 130 ± 17 86 ± 10 mmHg after 1 year, and to 140 ± 14 99 ± 9 mmHg at the last examination, ( p < 0.05). Serum creatinine and creatinine clearance remained stable over the observation period at 165 ± 56 μmol/L and 0.8 ± 0.4 ml/s/1.72m 2 at recruitment, and 152 ± 47 μmol/L and 1.0 ± 0.5 ml/s/1.72m 2 at the final examination. Proteinuria decreased from 3.2 to 1.4 g/24 h ( p < 0.05). No patient needed renal replacement therapy. In a reference group of hypertensive Type I diabetic patients with overt nephropathy who did not have the opportunity to participate in the hypertension treatment and teaching program, BP increased despite antihypertensive therapy from 143 ± 19 87 ± 10 mmHg to 160 ± 28 95 ± 13 mmHg (NS) while serum creatinine increased from 165 ± 32 to 410 ± 285 μmol/L ( p < 0.01). Four patients needed renal replacement therapy. These results indicate that after appropriate training, blind Type I diabetic patients with overt nephropathy may be able to achieve and maintain long-term normotension, and near-normal glycosylated hemoglobin values, which may have beneficial effects on renal function.