Pathological proteinuria in patients with insulin-dependent diabetes mellitus: relation to intensive insulin therapy.

Abstract

A matched case-control study was performed to assess the prevalence of pathological proteinuria (greater than 50 mg/l) 18-34 years after onset of insulin-dependent diabetes mellitus (IDDM), in relation to intensive insulin therapy. Three groups of patients were studied greater than or equal to 18 years after onset of IDDM. In patients of group A and group B, intervention took place greater than or equal to 8 years after onset of IDDM: group A changed from traditional insulin therapy to continuous subcutaneous insulin infusion (CSII), and patients of group B changed from traditional insulin treatment (less than 3 injections/day) to multiple daily insulin injection therapy. Patients of group C continued traditional insulin therapy without intervention. The prevalence of pathological proteinuria was 3/21, 5/21, and 15/21 in group A, B, and C, respectively; 22.0 (95% confidence interval: 19.5 to 24.5) years, 22.1 (19.9 to 24.3) years, and 22.6 (20.2 to 25.0) years after onset of IDDM in group A, B, and C. The prevalence of pathological proteinuria differed significantly between group A and B vs. group C (x2 = 16.2, p less than 0.001; odds ratio 15 (3.2 to 70.3)). Glycosylated haemoglobin was 7.5 (6.9 to 8.1)% in group A, 7.6 (6.3 to 8.3)% in group B, and 8.9 (8.2 to 9.6)% in group C. In group A and B, 4/21 patients had hypertension, compared to 11/21 patients in group C. In group B, 1/21 patients had serum-creatinine greater than 130 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)