Pulmonary function in diabetic children with and without persistent microalbuminuria

Verrotti, A.; Verini, M; Chiarelli, Francesco; Verdesca, V.; Misticoni, G.; Morgese, G

doi:10.1016/0168-8227(93)90066-e

Cited by 28 publications

(22 citation statements)

References 14 publications

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“…Some studies showed a significant reduction in the lung volumes of children with type 1 diabetes [4,5], while others showed a significant increase of airway resistance indexes but with normal lung volumes [6,7].…”

Section: Introductionmentioning

confidence: 98%

Impaired diffusing capacity for carbon monoxide in children with type 1 diabetes: is this the first sign of long-term complications?

et al. 2011

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We assessed the presence of lung dysfunction in children with type 1 diabetes, evaluated as reduced diffusing capacity of the lung for carbon monoxide (DLCO), and its components: membrane diffusing capacity (DM) and pulmonary capillary blood volume (Vc). A total of 42 children, aged 15.6 ± 3.8 years, with type 1 diabetes for 8.3 ± 5.5 years, and 30 healthy age and sex-matched peers were recruited for the study. Lung volumes and spirometric dynamic parameters were assessed by plethysmography. Single-breath DLCO was measured according to international recommendation. DM and Vc volume were calculated. Lung volumes were significantly reduced in young patients with type 1 diabetes when compared to controls. Moreover, DLCO was reduced in patients compared to controls (78% ± 16% vs. 120% ± 1%, P = 0.0001). However, when differentiating DM and Vc compartments, we observed a significant impairment only about Vc (34 ± 20 ml vs. 88 ± 18 ml; P = 0.0001), while no difference was observed about DM compartment (23 ± 4 vs. 26 ± 3 ml/min/mmHg, P = 0.798). Whether this might be seen as the "first" sign of microangiopathic involvement in patients with type 1 diabetes has to be confirmed on larger groups but is still fascinating. Meanwhile, we suggest to screen DLCO in all patients with type 1 diabetes.

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Section: Introductionmentioning

confidence: 98%

Impaired diffusing capacity for carbon monoxide in children with type 1 diabetes: is this the first sign of long-term complications?

et al. 2011

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“…Some studies, however, suggest a central role for IGF-1 that, in addition to directly modulating renal hemodynamics (8), may also mediate the effects of some of the above factors, such as growth hormone (9). The hypothesis that IGF-1 increases renal hemodynamics is consistent with the finding that IGF-1 serum levels are elevated in individuals with chronic renal failure (10,11) or diabetes (12) and that these levels are positively correlated with the the glomerular filtration rate (GFR) (13). Moreover, IGF-1 infusion increases both GFR and renal plasma flow (RPF) in diabetic and nondiabetic animals and humans with or without nephropathy (14 -18); the increase in GFR is sustained by an increase in both RPF and glomerular barrier hydraulic permeability, and that in RPF is sustained by a decrease in renal vascular resistances (RVR) (15).…”

mentioning

confidence: 71%

Renal and Metabolic Effects of Insulin Lispro in Type 2 Diabetic Subjects With Overt Nephropathy

et al. 2003

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OBJECTIVE -To assess whether the insulin analog lispro may antagonize the renal effects of IGF-1, a mediator of glomerular hyperfiltration involved in the progression of diabetic and nondiabetic chronic nephropathies. RESEARCH DESIGN AND METHODS-In a randomized crossover study, we compared the renal and metabolic responses to regular or lispro insulin (0.1 units/kg body wt) administered after a euglycemic clamp and 5 and 30 min before a standard meal to 11 type 2 diabetic patients with macroalbuminuria.RESULTS -Two-and four-hour postprandial changes (vs. preprandial euglycemia) in glomerular filtration rate (GFR) followed a significantly different trend (5.8 Ϯ 5.0 vs. Ϫ6.3 Ϯ 4.7, P Ͻ 0.05; and 11.0 Ϯ 6.8 vs. 0.7 Ϯ 5.1%, P Ͻ 0.05) after regular insulin and lispro injection, respectively. After lispro, postprandial GFR changes were negatively correlated (r ϭ Ϫ0.48, P ϭ 0.0001) with plasma insulin concentration. After regular insulin, renal plasma flow increased in parallel with a decrease in renal vascular resistances. Both changes were fully prevented by lispro. Postprandial blood glucose maximum concentration (278 Ϯ 16 vs. 240 Ϯ 16 mg/dl, P Ͻ 0.01) and area under the curve (79,381 Ϯ 19,237 vs. 72,810 Ϯ 16,211 mg/dl per min, P Ͻ 0,05) were significantly lower after insulin lispro than after regular insulin injection, respectively, despite comparable postprandial insulin profiles. Changes in total and gluconeogenic amino acids followed a similar trend. Changes in blood glucose and plasma amino acids did not correlate with concomitant changes in GFR.CONCLUSIONS -In overt nephropathy of type 2 diabetes, lispro prevents glomerular hyperfiltration and offsets the renal effects of meal or meal-associated hyperglycemia by mechanisms possibly related to IGF-1 antagonism. Diabetes Care 26:502-509, 2003

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“…However, new studies seem to point to the deleterious effect of high IGF-I levels in the development of microvascular complications. In fact, IGF-I plays a critical role in the development of diabetic retinopathy (48) and nephropathy (43) We have demonstrated that microalbuminuric patients have higher levels of both urinary and plasma IGF-I than normoalbuminuric diabetic subjects (50). Furthermore, IGF-I seems to enhance VEGF production, a cytokine with angiogenic effects implicated in the pathogenesis of vascular-related disease.…”

Section: Growth and Developmentmentioning

confidence: 99%

Growth, growth factors and diabetes

Chiarelli

Giannini²,

Mohn³

2004

European Journal of Endocrinology

109

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Type 1 diabetes mellitus (T1DM) and other chronic diseases in children are well known to adversely affect linear growth and pubertal development. In the years immediately following the introduction of insulin therapy, short stature was consistently reported in children with T1DM. However, over the past 50 years significant improvement in the prognosis for growth and final height in children with diabetes has been achieved. Although pre-pubertal and post-pubertal growth are important phases in growth, puberty and its related hormonal changes represent a critical phase for growth gain and final height particularly in patients with T1DM. Growth impairment reported in diabetic patients is dependent on abnormalities in physiological bone growth and corresponds to abnormalities of the growth hormone -insulin-like growth-I (GH -IGF-I) axis. These alterations seem to be related to appropriate insulin levels and thereby to glycaemic control as judged by haemoglobin levels. Modern diabetes care, particularly intensified insulin regimens, might improve metabolic control in patients with T1DM, therefore preventing abnormalities of the GH -IGF-I axis and leading to normal growth and final height similar to that of their unaffected peers. European Journal of Endocrinology 151 U109-U117

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Pulmonary function in diabetic children with and without persistent microalbuminuria

Cited by 28 publications

References 14 publications

Impaired diffusing capacity for carbon monoxide in children with type 1 diabetes: is this the first sign of long-term complications?

Impaired diffusing capacity for carbon monoxide in children with type 1 diabetes: is this the first sign of long-term complications?

Renal and Metabolic Effects of Insulin Lispro in Type 2 Diabetic Subjects With Overt Nephropathy

Growth, growth factors and diabetes

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