Risk factors for progression of background retinopathy in long-standing IDDM

Janka, H. U.; Warram, James H.; Rand, L. I.; Królewski, A. S.

doi:10.2337/diabetes.38.4.460

Cited by 72 publications

(44 citation statements)

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“…There are numerous observations that hGH is elevated in poorly controlled diabetes mellitus, which focused attention on the role of the hGH axis as the mediator of pituitary ablation in PDR (9)(10)(11)(12)42 (45,46). These studies provide evidence ofaltered control ofhGH secretion without addressing whether hGH has biologic effects that may modify the course of retinopathy.…”

Section: Discussionmentioning

confidence: 99%

Human growth hormone stimulates proliferation of human retinal microvascular endothelial cells in vitro.

Rymaszewski

Cohen

Chomczyński

1991

Proc. Natl. Acad. Sci. U.S.A.

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Growth hormone (GH) has been implicated in the pathogenesis of proliferative diabetic retinopathy. We sought to determine whether this could be mediated by an effect of GH on proliferation of endothelial cells, and, for this purpose, established long-term cultures of human retinal microvascular endothelial cells (hREC) from normal postmortem human eyes. High-purity (>95%) hREC preparations were selected for experiments, based on immunofluorescence with acetylated low density lipoprotein (LDL) and anti-factor VIIIrelated antigen. Growth requirements for these cells were complex, including serum for maintenance at slow growth rates and additional mitogens for more rapid proliferation. Exposure ofhREC to physiologic doses ofhuman GH (hGH) resulted in 100% greater cell number vs. control (P < 0.01) but could be elicited only in the presence of serum. When differing serum conditions were compared, hGH stimulated [3H]thymidine incorporation up to 1.6-to 2.2-fold under each condition and increased DNA content significantly in the presence of human, horse, and fetal calf serum. Depending on the culture conditions used, the threshold hGH concentration for significant stimulation of hREC proliferation was 0.4-4 pg/liter. In contrast, proliferation of human umbilical vein endothelial cells was not significantly altered by hGH added to concentrations as high as 200 pzg/liter. In summary, hREC respond to physiologic concentrations of hGH in vitro with enhanced proliferation. This specific effect of GH on retinal microvascular endothelial cells supports the hypothesis of a role for GH in endothelial cell biology.

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Section: Discussionmentioning

confidence: 99%

Human growth hormone stimulates proliferation of human retinal microvascular endothelial cells in vitro.

Rymaszewski

Cohen

Chomczyński

1991

Proc. Natl. Acad. Sci. U.S.A.

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“…In Type I (insulin-dependent) diabetes mellitus, raised blood pressure has been shown to be related to an increased risk of retinopathy [1,2,3], and cardiovascular disease [4,5] in several prospective studies independent of other risk factors. It is estimated that 30 to 75% of diabetic complications can be attributed to hypertension, which is twice as common in diabetic patients than in non-diabetic…”

Section: Ccb Calcium Channel Blockermentioning

confidence: 99%

Trends in hypertension management in Type I diabetes across Europe, 1989/1990 – 1997/1999

et al. 2002

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Aims/hypothesis Our aim was to examine the change in the management of hypertension in patients with Type I (insulin-dependent) diabetes mellitus in Europe, between 1989Europe, between -1990Europe, between and 1997Europe, between -1999.Methods Seven-year changes in hypertension treatment and control (defined as blood pressure <130/85 mmHg) were examined in a large sample of Type I diabetic patients recruited from 26 centres involved in the EURODIAB Prospective Complications Study. Hypertension was defined as a systolic and/or diastolic blood pressure greater than 140 and/or 90 mmHg respectively, and/or use of blood pressure lowering drugs. 1Results Of 1866 Type I diabetic patients, 412 had hypertension at baseline and 631 at follow-up.A greater proportion of hypertensive patients were treated at follow-up (69% vs 40%, p<0.0001), which persisted after adjustment for age or centre. Of those who were treated, a modest increase in the proportion of those controlled for hypertension was found (41% vs 32%, p=0.048), which disappeared after adjustment for age. Among hypertensive patients with albuminuria, the proportions treated also increased, from 35% to 76% (p<0.0001) in microalbuminuric and 64% to 95% (p<0.0001) in macroalbuminuric patients. Control of hypertension in albuminuric patients did not change significantly and was below 50%. The use of more than one anti-hypertensive drug increased over a 7-year period, from 19% to 33% (p<0.0001), and a marked increase was shown in the proportion of those taking an ACE inhibitor (from 57% to 82%, p<0.0001). Conclusion/interpretationThe management of hypertension in Type I diabetic patients acrossEurope has improved over a 7-year follow-up period. Optimal levels of blood pressure treatment and optimal levels of control have not yet been achieved.Keywords Hypertension · Type I diabetes mellitus · albuminuria · control · blood pressure · treatment Abbreviations CCB Calcium channel blockerAn erratum to this article can be found at http://dx.doi.org/10.1007/s00125-003-1210-9In Type I (insulin-dependent) diabetes mellitus, raised blood pressure has been shown to be related to an increased risk of retinopathy [1,2,3], and cardiovascular disease [4,5] in several prospective studies independent of other risk factors. It is estimated that 30 to 75% of diabetic complications can be attributed to hypertension, which is twice as common in diabetic patients than in non-diabeticSeveral BP lowering trials have shown a reduction in microvascular and macrovascular complications in patients with Type II (non-insulin-dependent) diabetes mellitus [7,8]. Other recent trials have shown that, independent from BP lowering effects, the progression of diabetic nephropathy can be reduced by angiotensin II receptor blockers in Type II diabetic patients with hypertension and albuminuria [9,10,11]. In Type I diabetes, the progression of retinopathy [12]

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“…[2][3][4][5] Proteinuria and microalbuminuria in patients with type 1 diabetes are known to be associated with several adverse cardiovascular risk factors, including hypertension and lipoprotein abnormalities, characterized mainly by elevated serum total and LDL cholesterol and high total and VLDL triglyceride levels, low HDL cholesterol, and low ApoA1 levels. 6 -8 Chronic hyperglycemia 9 -12 and poor glycemic control [13][14][15][16] have been implicated in the pathogenesis of microvascular complications in patients with type 1 diabetes, but little data are available on the role of these factors for the development of macrovascular complications.…”

mentioning

confidence: 99%

Poor Glycemic Control Predicts Coronary Heart Disease Events in Patients With Type 1 Diabetes Without Nephropathy

Lehto

Rönnemaa

Pyörälà

et al. 1999

ATVB

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Abstract-Patients with type 1 diabetes mellitus, especially those with nephropathy, are at increased risk for coronary heart disease (CHD). However, information on the predictive value of cardiovascular risk factors and the degree of hyperglycemia with respect to CHD events in patients with type 1 diabetes without nephropathy is still incomplete. Therefore, we performed a prospective study on risk factors for CHD in patients with type 1 diabetes free of clinical nephropathy. At baseline examination, cardiovascular risk factor levels of CHD were determined in 177 patients with type 1 diabetes (87 men and 90 women), age 45 to 64 years at baseline and Ն30 years at the time of diagnosis of diabetes. These patients were followed up to 7 years with respect to CHD events.

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Risk factors for progression of background retinopathy in long-standing IDDM

Cited by 72 publications

References 0 publications

Human growth hormone stimulates proliferation of human retinal microvascular endothelial cells in vitro.

Human growth hormone stimulates proliferation of human retinal microvascular endothelial cells in vitro.

Trends in hypertension management in Type I diabetes across Europe, 1989/1990 – 1997/1999

Poor Glycemic Control Predicts Coronary Heart Disease Events in Patients With Type 1 Diabetes Without Nephropathy

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