Effect of Control of Blood Glucose on Urinary Excretion of Albumin and β<sub>2</sub>Microglobulin in Insulin-Dependent Diabetes

Gc, Viberti; Jc, Pickup; Rj, Jarrett; Keen, H.

doi:10.1056/nejm197903223001202

Cited by 299 publications

(85 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An abnormal value could be a transient phenomenon due to a number of factors, even perhaps changes in glucose levels (17). Our data could be consistent with this concept because there was a marked association between albumin excretion and fasting glucose levels.…”

Section: Sosenko Kato and Goldbergsupporting

confidence: 84%

Sensory Function and Albumin Excretion According to Diagnostic Criteria for Diabetes

Sosenko¹,

Kato²,

Goldberg³

2004

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVE -The purpose of this study was to examine sensory function and albumin excretion according to categories of glucose tolerance in individuals undergoing screening for diabetes. RESEARCH DESIGN AND METHODS-Sensory function and albumin excretion measurements were obtained in 636 individuals at the time of screening for diabetes according to American Diabetes Association glucose tolerance criteria. Sensory thresholds were measured by forced-choice techniques. Albumin-to-creatinine ratios were calculated from spot urine samples.RESULTS -Of 90 individuals whose glucose levels were in the range for diabetes, 65 had fasting glucose values Ն126 mg/dl, whereas 25 had 2-h glucose values Ն200 mg/dl, with fasting glucose values Ͻ126 mg/dl. In covariance analyses, those with fasting glucose levels Ն126 mg/dl had higher vibration (P Ͻ 0.01) and thermal (P Ͻ 0.05 for cool and warm) thresholds than those with normal glucose tolerance. This pattern was also evident for albumin-to-creatinine ratios (P Ͻ 0.001). In contrast, those with 2-h glucose values Ն200 mg/dl and fasting glucose values Ͻ126 mg/dl had sensory threshold and albumin-to-creatinine ratio values similar to those of the normal group. Individuals with fasting glucose levels Ն126 mg/dl had higher vibration threshold and albumin-to-creatinine ratio values (Ͻ0.05 and Ͻ0.01, respectively) than those with levels Ͻ126 mg/dl. CONCLUSIONS -Sensory threshold and albumin excretion values already tend to be greater than normal at screening in individuals with fasting glucose levels Ն126 mg/dl, but not in those with levels Ͻ126 mg/dl. A reliance on fasting glucose levels Ն126 mg/dl for screening might not be sufficient for early intervention and the optimal prevention of diabetes complications. Diabetes Care 27:1716 -1720, 2004T ype 2 diabetes is characterized as a condition in which insulin resistance precedes the development of hyperglycemia (1). With eventual worsening of pancreatic ␤-cell function, hyperglycemia tends to become more pronounced (1). Given this progression from insulin resistance to the development and increasing severity of hyperglycemia, it is unclear at what stage of the pathologic process individuals should be classified as having type 2 diabetes.The criteria for type 2 diabetes have essentially been based on the degree of hyperglycemia. In 1979, the National Diabetes Data Group recommended that fasting glucose levels Ն140 mg/dl or 2-h glucose levels Ն200 mg/dl should be used as criteria for diabetes (2). More recently, the American Diabetes Association (ADA) has recommended that the fasting glucose criterion be lowered to Ն126 mg/dl (3). Although the rationale for this modification was based on several factors, a major consideration was the low frequency of retinopathy in individuals whose fasting glucose levels were Ͻ126 mg/dl.There is less information available with regard to glucose thresholds for other complications of diabetes. Data are particularly sparse regarding the prevalence of these complications at the time of diagnosis of type 2 di...

show abstract

Section: Sosenko Kato and Goldbergsupporting

confidence: 84%

Sensory Function and Albumin Excretion According to Diagnostic Criteria for Diabetes

Sosenko¹,

Kato²,

Goldberg³

2004

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…In contrast, measures of the extent of mesangial expansion and peripheral capillary surface were related to levels of albuminuria that would be clinically detectable by Albustix. It is known that the microalbuminuria of diabetic patients without clinical nephropathy (4,5) is reversible by the institution of short-term strict glycemic control (5), whereas in diabetic patients with overt proteinuria, fractional IgG and albumin clearances continue to increase and GFR continues to decrease despite 6 mo of strict glycemic control (41). It is also known that the onset of overt proteinuria ushers in the development of a progressive deterioration in the macromolecular permselective characteristics of the glomerular barrier (38,42).…”

Section: Discussionmentioning

confidence: 99%

Structural-functional relationships in diabetic nephropathy.

Steffes²,

et al. 1984

View full text Add to dashboard Cite

A s bstract. Renal biopsies in 45 patients with insulin-dependent diabetes mellitus (IDDM) were examined by semiquantitative light microscopy and quantitative electron microscopic stereologic morphometry. In these 14 males and 31 females, aged 13-52 yr, who had had IDDM for 2.5-29 yr there was no strong relationship between either glomerular basement membrane (GBM) thickness or mesangial expansion and duration of IDDM. There was only a weak relationship between the thickness of the GBM and expansion of the mesangium. Thus, GBM thickening and mesangial expansion in IDDM occur at rates that often differ from one another and that vary greatly among patients. The clinical manifestations of diabetic nephropathy, albuminuria, hypertension, and decreased glomerular filtration rate related poorly or not at all to GBM thickening. In contrast, all light and electron microscopic measures of mesangial expansion were strongly related to the clinical manifestations of diabetic nephropathy, although in the absence of these clinical findings, it was not possible to predict the severity of any of the diabetic glomerular lesions. Mesangial expansion had strong inverse correlations with capillary filtering surface area density. It is hypothesized that mesangial expansion could lead to glomerular functional deterioration in IDDM by restricting the glomerular capillary vasculature and its filtering surface. However, capillary closure, glomerular sclerosis, and interstitial fibrosis could also contribute to the clinical manifestations of this disorder.

show abstract

“…Evidence both for and against comes largely from populations of Type II diabetics. Viberti et al (1979Viberti et al ( , 1981 showed that near-normoglycaemia produced by continuous subcutaneous insulin infusion in Type I diabetics rapidly reduced elevated levels of albumin uria measured by the sensitive radioimmunoassay.…”

Section: Factors Affecting Rate Of Progression Of Nephropathymentioning

confidence: 99%

Factors related to diabetic microangiopathy.

Jarrett

1983

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Abnormalities of the micro-circulation, in diabetics have been described in many organs and tissues, including the myocardium. However, the major clinical problems affect the retina and the kidneys, unless one believes that neuropathy is also primarily a vascular disorder, which I do not. In this review, therefore, I shall discuss those factors which are related to retinopathy and nephropathy and which may play some role in their genesis, frequency and severity. DIABETIC RETINOPATHYThis omnibus term includes several abnormalities, none being specific to diabetes, which can occur singly or severally in the diabetic. The wide variety of ophthalmoscopic or angiographic appearances has made classification and description difficult and also complicates attempts to establish associations. Nevertheless, it is clear from many studies that a major associated factor is the duration of diabetes. This has been mainly studied in prevalence surveys. Thus Burditt et al. (1968), in a study of over 2,000 patients in Oxford, England, noted that the prevalence of retinopathy where the duration of known diabetes was less than five years was 4% in those aged below 30 years, 22% in those aged 30-59 years and 34% in those aged 60 and above. Of course, many diabetics present with retinopathy. In the Birmingham clinic Soler et al. (1969) reported that at diagnosis the prevalence of retinopathy was 1.5% in diabetics aged 30-40 years rising to 7% in those aged 50-60 years and about 10% thereafter. The usual explanation for this is that there is a period of undiagnosed, often asymptomatic, diabetes preceding diagnosis and this has received support from prospective observations on diabetics diagnosed by blood glucose screening and then followed over several years (Al Sayegh and Jarrett 1979;Jarrett and Keen 1976).These studies have also shown that a sufficient degree or threshold level of hyperglycaemia and/or glucose intolerance must be exceeded before significant retinal lesions appear.Whether or not the prevalence of retinopathy varies between different ethnic groups is still unresolved. It is very difficult to study, involving problems in population sampling in addition to those of clssification and observation of retinal 325

show abstract

Effect of Control of Blood Glucose on Urinary Excretion of Albumin and β₂Microglobulin in Insulin-Dependent Diabetes

Cited by 299 publications

References 10 publications

Sensory Function and Albumin Excretion According to Diagnostic Criteria for Diabetes

Sensory Function and Albumin Excretion According to Diagnostic Criteria for Diabetes

Structural-functional relationships in diabetic nephropathy.

Factors related to diabetic microangiopathy.

Contact Info

Product

Resources

About

Effect of Control of Blood Glucose on Urinary Excretion of Albumin and β2Microglobulin in Insulin-Dependent Diabetes

Cited by 299 publications

References 10 publications

Sensory Function and Albumin Excretion According to Diagnostic Criteria for Diabetes

Sensory Function and Albumin Excretion According to Diagnostic Criteria for Diabetes

Structural-functional relationships in diabetic nephropathy.

Factors related to diabetic microangiopathy.

Contact Info

Product

Resources

About

Effect of Control of Blood Glucose on Urinary Excretion of Albumin and β₂Microglobulin in Insulin-Dependent Diabetes