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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To detect early renal involvement in young diabetic patients (IDDM), urinary protein excretion and renal function were examined in 110 patients aged 5.9-25.0 years. Clearances of inulin and PAH were determined as well as albumin (Alb), IgG, N-acetyl-beta-D-glucosaminidase (NAG) and creatinine (Cr) excretion rates (UV). The patients were grouped according to IDDM duration (2- less than 5, 5-10 and greater than 10 years) and albumin excretion rate (non-albuminuria less than 20, microalbuminuria 20-200, and albuminuria greater than 200 micrograms/min per 1.73 m2). Four patients had overt albuminuria, 17 microalbuminuria (equally distributed among the duration groups). Grouped according to albumin excretion rate, the mean GFR was increased in those without albuminuria but 'normalized' in patients with microalbuminuria/albuminuria. Grouped according to albumin excretion rate and the duration of the disease, the non-albuminuric patients with IDDM for greater than 10 years had a lower GFR than those with a shorter duration of IDDM. The patients with microalbuminuria/albuminuria and IDDM for less than 5 years had a reduced GFR. Patients with increased NAG excretion rate had lower Na excretion rate, lower fractional Na excretion and greater creatinine excretion than those with normal NAG excretion. Albumin excretion correlated with IgG excretion, but also with NAG excretion. Our results suggest that early albuminuria in IDDM is of both glomerular and tubular origin. The hyperfiltration declines with increasing albumin excretion but also with the duration of the disease.
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PMID:Urinary protein excretion and renal function in young people with diabetes mellitus. 132 Feb 27

In insulin-dependent diabetes (IDDM), an overactivity of sodium-lithium countertransport (Na+/Li+ CT) has been associated with the risk of nephropathy and hypertension, two conditions of insulin resistance. We investigated the sensitivity to insulin with a hyperinsulinemic (approximately 719 pM [approximately 100 microU/ml]) euglycemic clamp in two groups of normotensive nonproteinuric IDDM patients; 12 (10 men, 2 women) had high Na+/Li+ CT activity (mean 0.47, range 0.42-0.68 mmol/L red blood cells [RBC]/h, group 1) and 12 (9 men, 3 women) had normal Na+/Li+ CT activity (mean 0.24, range 0.12-0.31 mmol/L RBC/h, group 2). The two groups were similar in age (mean +/- SE 36 +/- 2 vs. 33 +/- 1 yr), duration of diabetes (19 +/- 3 vs. 18 +/- 2 yr), body mass index (26 +/- 0.8 vs. 24 +/- 0.6 kg/m2), arterial blood pressure (systolic/diastolic 121 +/- 4/79 +/- 2 vs. 122 +/- 3/77 +/- 2 mmHg), and glycemic control (HbA1 8.5 +/- 0.4 vs. 8.0 +/- 0.4%). Albumin excretion rate (AER) ranged between 4.7 and 148 (geometric mean 14) micrograms/min in group 1 and between 2.7 and 93 (geometric mean 11) micrograms/min in group 2. There were four microalbuminuric patients (AER greater than 30 micrograms/min) in each group. Whole-body glucose uptake was significantly reduced on average in group 1 compared with group 2 (41.6 +/- 2.2 mumol.kg-1.min-1 [7.48 +/- 0.4 mg.kg-1.min-1] vs. 49.6 +/- 2.2 mumol.kg-1.min-1 [8.93 +/- 0.4 mg.kg-1.min-1, P = 0.03), but some overlap existed between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sodium-lithium countertransport activity and insulin resistance in normotensive IDDM patients. 153 93

Glomerular and tubular microproteinuria precede the development of overt nephropathy in Type 1 diabetes mellitus. However, in Type 2 diabetes urinary protein excretion and its relationship to diabetic nephropathy has not been clearly characterized. Twenty consecutive, newly diagnosed patients with Type 2 diabetes, whose urine was Albustix-negative and sterile on culture, were studied. Two timed overnight urine samples were collected at diagnosis, and after 2 months and 2 years, and excretion rates of albumin, alpha-1-microglobulin and N-acetyl-beta-D-glucosaminidase were calculated. HbA1c fell from 12.1 +/- 2.4% at diagnosis to 9.5 +/- 1.5% at 2 months and 9.6 +/- 2.2% at 2 years. Albumin excretion rate fell marginally from 6.5 (2.1-242.5) micrograms min-1 at diagnosis to 5.5 (1.7-274.0) micrograms min-1 at 2 months (p less than 0.05) rising again to 6.1 (1.9-201.7) micrograms min-1 at 2 years. alpha-1-Microglobulin excretion rate fell from 13.5 (3.6-59.9) micrograms min-1 at diagnosis to 8.4 (2.9-16.1) micrograms min-1 at 2 months and 8.8 (1.8-54.1) micrograms min-1 at 2 years (both p less than 0.05). Albumin excretion rate was found to correlate significantly with creatinine clearance at diagnosis (rs = 0.61, p less than 0.005), though not subsequently. In contrast, excretion rates of alpha-1-microglobulin and N-acetyl-beta-D-glucosaminidase correlated with HbA1c (rs = 0.68 and 0.66, respectively, p less than 0.005 at diagnosis and rs = 0.57 and 0.53, p less than 0.05 subsequently in both cases).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Microproteinuria in type 2 diabetes mellitus from diagnosis. 169 21

The relationship between long-term blood glucose control and albuminuria in type 1 diabetes was investigated in 42 male and 58 female patients who had had diabetes mellitus for more than 7 years. Their mean (+/- SD) age and diabetes duration were 18.6 +/- 3.6 and 12.1 +/- 3.5 years, respectively. For periods of observation ranging from 1 to 6 years (mean 4.4 +/- 1.5), hemoglobin A1c (HbA1c) was measured two to six times yearly (mean of 8.8 +/- 3.9 determinations per patient). Albumin excretion rate (AER) was measured in single-void urine samples two to four times in 93 patients and once in the other seven patients. The 52 patients with mean HbA1c no more than 9.0% had significantly lower mean AER than those whose HbA1c was greater than 9.0% (20.1 +/- 24.6 vs 265 +/- 1005 mg/gm Cr, p less than 0.001). Only five (9.6%) of these 52 patients had elevated AER values (greater than 40 mg/gm Cr), whereas 21 (43.7%) of 48 patients whose mean HbA1c was greater than 9.0% had elevated AER values (p less than 0.001). Six male but no female patients had mean AER values greater than 300 mg/gm Cr. The 74 patients with normal AER had significantly lower mean HbA1c values than the 26 with elevated AER (8.6 +/- 1.5 vs 10.1 +/- 1.6%, p less than 0.001). These results support the contention that maintenance of HbA1c levels at no more than 9% (one and one-half times the upper limit of normal) will significantly decrease the likelihood that diabetic nephropathy will develop.
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PMID:Blood glucose control and albuminuria in type 1 diabetes mellitus. 186 Dec 3

The effect of the mucolytic agent bromhexine, 72 mg daily for one month, on albumin excretion in insulin dependent diabetes was investigated in a double-blind, randomised, cross-over, placebo-controlled study. Nine patients with normal albumin excretion [overnight albumin excretion rate 3.2 (2.1-8.8) micrograms/min.; mean (range)], six with microalbuminuria [36 (22-95) micrograms/min.] and six with macroalbuminuria [321 (201-1215) micrograms/min.] participated. Albumin excretion was similar after treatment with bromhexine and placebo in all 3 groups [normoalbuminurics 3.6 (1.7-13.5) versus 3.3 (1.9-13.2) micrograms/min.; microalbuminurics 40 (20-128) versus 37 (20-103); macroalbuminurics 396 (247-2160) versus 443 (292-2592)]. Excretion of beta 2-microglobulin and creatinine clearance were identical at the end of each treatment. Blood glucose control and blood pressure remained constant throughout the study in the 3 groups. We conclude that bromhexine 72 mg daily for 1 month had no effect on albumin excretion in IDDM patients with normal and pathological albuminuria.
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PMID:The effect of bromhexine on albumin excretion in insulin dependent diabetes. 188 76

Albumin excretion rate measured by new immunoassays and semiquantitative tests is advocated as a means for early detection of diabetic nephropathy. We determined albumin excretion rate in 276 patients. Albumin excretion rate was normal in 66%, within the microalbuminuric range in 27%, and within the macroproteinuric range in 7%. Significant predictors of albumin excretion rate included presence of hypertension and glycosylated hemoglobin level in type I diabetes mellitus, and years since diagnosis in type II diabetes mellitus. A semiquantitative test was deemed to be of limited diagnostic value. We conclude that testing for early diabetic nephropathy in routine clinical practice gives valuable information and that determination by a quantitative immunoassay based on a single 24-hour urine sample is preferable. The optimal frequency of screening and the levels that determine progressive renal disease have yet to be established.
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PMID:Microalbuminuria in clinical practice. 188 40

Urinary albumin, measured by radioimmunoassay, was evaluated as a method to assess early renal impairment in 76 insulin (IDD) and 36 noninsulin (NIDD)-dependent diabetic patients. Mean albumin excretion in IDD and NIDD patients was significantly higher at 23 and 12 micrograms/100 ml glomerular filtrate (GF) respectively, compared to 4 micrograms/100 ml GF in normal subjects (P less than 0.001 and P less than 0.05). Abnormal albumin excretion from 20 to 200 micrograms/100 ml GF was observed in 30% of IDD patients (P less than 0.001) and 15% of NIDD patients (P less than 0.03). Albumin excretion was significantly increased in hypertensive IDD and NIDD patients. Significant correlations between albumin excretion and age, duration of diabetes and creatinine clearance were observed, but albumin excretion did not correlate with hemoglobin A1C. These data indicate that (1) 30% of IDD patients not clinically recognized as having renal impairment have abnormal albumin excretion, (2) albumin excretion may reflect renal impairment, since albumin excretion levels independently correlate with duration of diabetes and hypertension in both diabetic subgroups and to glomerular function in NIDD patients, and (3) measurement of urinary albumin by radioimmunoassay may be the most sensitive test to evaluate early renal disease in diabetes.
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PMID:The interrelationships of radioimmunoassayable urinary albumin, renal function and diabetes. 372 Apr 98

Cardiovascular complications are the main cause of disability and deaths in insulin dependent diabetic patients. The main aim of the EURODIAB IDDM Complications Study was to assess the prevalence of diabetes complications and of risk factors of these complications. In this study the data on cardiovascular diseases and their risk factors in patients included in the EURODIAB IDDM Complications Study--Krakow are presented. The study population included insulin dependent clinic attenders, aged 15-60 years, diagnosed before the age of 36 years. A random sample of up to 140 patients stratified by age, sex and duration of diabetes was chosen. Within each centre the study population consisted of all eligible IDDM patients living in a defined catchement area, who had attended the center at least once during the preceding 12 months. The studied sample included 120 patients (61 men and 59 women). Mean (sd) age of patients was 34.0 (9.6) years, mean duration of diabetes 14.2 (9.8) years, mean Hb A1c concentration 6.6 (1.5)%. The prevalence of cardiovascular diseases was assessed using standardized questionnaire and resting electrocardiogram. Blood pressure was measured with "random zero" sphygmomanometer. Electrocardiogram was assessed according to Minnesota code. Serum cholesterol and triglyceride concentration were determined by enzymatic methods. Albumin excretion rate was determined in 24 hours urine collection. Albumin concentration was assayed by immunoturbidimetry. Cardiovascular diseases were observed in 8.3% of patients. Arterial hypertension (WHO dfn) was found in 11.7% of patients, systolic blood pressure > or = 140 mm Hg in 9.2% of patients and diastolic blood pressure > or = 90 mm Hg in about 5% of men and 2% of women. Hypercholesterolemia (serum cholesterol > or = 6.5 mmol/l) was found in about 20% of patients, hypertriglyceridemia (serum triglyceride 2.2 mmol/1) in 16.4% of men and 10.2% of women. 41.0% of men and 28.8% of women were current cigarette smokers. Microalbuminuria (defined as albumin excretion rate 20-200 micrograms/min) was observed in 23% of men and 15.3% of women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Coronary risk factors in a group of patients with insulin dependent diabetes mellitus--examination of the EURODIAB IDDM Complications Study Krakow]. 787 Nov 92

We investigated in a randomized, prospective study the influence of improved blood glucose control during 2-3 years in young insulin-dependent diabetic (IDDM) patients with microalbuminuria, which is indicative of early nephropathy. Patients were randomized either to intensive treatment by continuous subcutaneous insulin infusion (CSII) (n = 9) or CT (n = 9). Kidney biopsies were taken at baseline and after 26-34 months. End points were structural changes in the glomeruli. Sensitive, quantitative, morphometric methods were used. The blood glucose control improved significantly (p = 0.01) during the study in the CSII-group as glycated haemoglobin (HbA1c) fell from 10.1% ([95% CI] 8.9-11.3) to 8.6% (7.9-9.2), but not in the CT-group, 10.1% (8.3-11.9) vs 9.7% (8.7-10.8). Mean HbA1c during the study period was significantly lower in the CSII-group than in the CT-group, 8.7% (8.1-9.3) vs 9.9% (8.5-11.3), p = 0.04. Basement membrane thickness (BMT) increased in both groups, most (CT vs CSII, p = 0.03) in the CT-group: 140 nm (50-230) vs CSII: 56 nm (27-86). In the CT-group only an increase was seen in matrix/mesangial volume fraction (p = 0.006) and matrix star volume (p = 0.04). Furthermore, a positive correlation between mean HbA1c during the study and change from baseline in BMT (r = 0.70, p = 0.001) and matrix/glomerular volume fraction (r = 0.33, p = 0.09, NS) was demonstrated. Albumin excretion rate correlated significantly to BMT and most of the matrix parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Improvement of blood glucose control in IDDM patients retards the progression of morphological changes in early diabetic nephropathy. 805 86

Microalbuminuria in both insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) is a marker for insulin resistance. Microalbuminuria is also associated with hypertension, itself an insulin-resistant state. Therefore, in order to examine the independent relationships of microalbuminuria with blood pressure and insulin resistance, we measured ambulatory blood pressure (Takeda TM-2420), insulin resistance (modified Harano method), and urinary albumin excretion rate (overnight urine collection) in 36 subjects with NIDDM. Albumin excretion correlated with 24-h systolic blood pressure (r = 0.49, p = 0.003), and insulin sensitivity (r = -0.39, p = 0.007). Microalbuminuric subjects had reduced insulin sensitivity compared with normoalbuminuric subjects [Mean (SD) 2.95 (0.33) versus 4.67 (0.56) ml.kg-1.min-1; p = 0.013]. In multivariate analysis including ambulatory blood pressure and insulin resistance, urinary albumin excretion was associated primarily with insulin resistance, with smaller contributions from glycated hemoglobin and male gender. These data suggest that microalbuminuria in NIDDM, although associated with hypertension, is also independently associated with insulin resistance.
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PMID:Insulin resistance in non-insulin-dependent diabetes mellitus is associated with microalbuminuria independently of ambulatory blood pressure. 857 34


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