Low prevalence of microalbuminuria in normotensive patients with insulin-dependent diabetes mellitus

We studied the prevalence of microalbuminuria (urinary albumin excretion rate [UAER] greater than 20 micrograms/min less than or equal to 200 micrograms/min) as determined in a single, timed, overnight urine collection in 156 normotensive (BP less than 140/90), Albustix negative subjects with type 1 diabetes and its association with arterial blood pressure, the duration of diabetes, levels of glycosylated hemoglobin, body mass index, daily insulin dose and serum cholesterol. Nineteen subjects (12.2%) had a UAER in the microalbuminuric range. The microalbuminuric patients had a significantly longer duration of diabetes, 21 +/- 2 vs 15 +/- 1 years (P less than 0.01), higher diastolic blood pressure, 80 +/- 2 vs 76 +/- 1 mmHg (P less than 0.05) and serum cholesterol concentration, 206 +/- 11 vs 186 +/- 3 mg/dl (P less than 0.05) than did the normoalbuminuric subjects. There were no differences between the normoalbuminuric and microalbuminuric subjects in terms of age, systolic blood pressure, body mass index, daily insulin dose or glycosylated hemoglobin levels. These data indicate that the prevalence of microalbuminuria in type 1 diabetes has probably been overestimated in previous studies due to the inclusion of patients with hypertension. Thus, microalbuminuria, rather than being a predictor of the development of diabetic renal disease, may indicate the presence of diabetic nephropathy with rising blood pressure levels. Further investigation is needed to clarify the relationship between microalbuminuria and coronary risk factors such as serum cholesterol and diastolic blood pressure levels.     

Serum lipids and lipoproteins in insulin-dependent diabetic patients with persistent microalbuminuria

Serum lipid and lipoprotein concentrations were measured in 18 insulin-dependent diabetic patients with persistent microalbuminuria and an equal number with persistently normal albumin excretion. The groups were matched for sex, age, duration of diabetes, body mass index, insulin dose, and glycosylated haemoglobin. Diabetic patients with persistent microalbuminuria were found to have a significantly lower high density lipoprotein (HDL) cholesterol concentration (difference 0.29, 95% Cl 0.12 to 0.46, mmol l-1, p less than 0.01) and a higher low density lipoprotein (LDL) cholesterol:HDL cholesterol ratio (difference 0.97, 95% Cl 0.29 to 1.65, p less than 0.01) than patients with normal albumin excretion. No significant differences were found in total cholesterol, triglycerides, LDL cholesterol, apolipoprotein (apo) A-I and apo B concentrations. Compared to an age and sex-matched group of non-diabetic subjects with normal albumin excretion, diabetic patients with persistent microalbuminuria had significantly higher concentrations of total cholesterol (p less than 0.05), LDL cholesterol (p less than 0.05) and apo B (p less than 0.01), but a lower concentration of HDL cholesterol (p less than 0.05). No significant differences were found in serum lipids and lipoproteins between diabetic patients with normal albumin excretion and non-diabetic subjects.     

Benfluorex and blood glucose control in non insulin-dependent diabetic patients

Benfluorex has been reported to decrease blood glucose in different dismetabolic conditions, particularly in noninsulin-dependent diabetic (NIDD) patients, but the mechanism of this effect is poorly known. We evaluate fasting glucose production (3H-glucose infusion) and B-cell secretion (phi 1, phi 2 and glucose utilization SI) (minimal model technique) in 7 mild, diet treated, NIDDM patients after 6-week administration of benfluorex (450 mg/day) and placebo, in random sequence and double blind design. Body weight, HbA1c, plasma glucose profile, fasting plasma insulin, lactate, pyruvate, beta-OH-butyrate, total cholesterol, HDL-cholesterol and triglycerides were also measured at the end of each treatment. Mean values of body weight (71 +/- 4 vs 69 +/- 4 kg, p less than 0.01), HbA1c (8.3 +/- 0.2 vs 7.7 +/- 0.2%, p less than 0.01), fasting plasma glucose (137.0 +/- 6.5 vs 121.4 +/- 5.6 mg/dl, p less than 0.01), lactate (1.82 +/- 0.13 vs 1.22 +/- 0.11 mmol/l, p less than 0.0025) pyruvate (0.164 +/- 0.011 vs 0.095 +/- 0.010 mmol/l, p less than 0.0005), and beta-OH-butyrate (0.91 +/- 0.06 vs 0.66 +/- 0.04 mmol/l, p less than 0.005) were significantly lower after benfluorex than after placebo. phi 1, phi 2 and SI values were not significantly different in the two treatments. Fasting glucose production was significantly lower after benfluorex than after placebo: 2.46 +/- 1.57 vs 1.84 +/- 0.85 mg/kg.min, p less than 0.02. These results demonstrate that 6-week treatment with benfluorex produces a significant blood glucose lowering effect in mild NIDDM patients, mainly by decreasing glucose production.     

High plasma prorenin in non diabetic siblings of non insulin-dependent diabetes mellitus patients

In a large cohort (no. = 361) of NIDDM probands and their concordant/discordant siblings from no. = 132 families we studied: 1. the levels of plasma prorenin in non affected siblings of NIDDM probands as opposed to normal subjects without family history of diabetes, and 2. whether plasma prorenin raises in parallel to urinary protein loss in NIDDM patients. Prorenin (solid-phase trypsin) and micro-macroalbuminuria (radioimmunoassay) were evaluated. Plasma prorenin was higher in NIDDM probands and siblings than in non NIDDM siblings (37+/-31 vs. 25+/-15 ng/ml/h, p<0.0005) who, in turn, showed higher plasma prorenin than non diabetic controls without family history of diabetes (25+/-15 vs. 17+/-8 ng/ml/h, p<0.005). Plasma prorenin was higher in NIDDM siblings of micro-macroalbuminuric probands than in NIDDM siblings of non micro-macroalbuminuric probands (40+/-26 vs. 29+/-20 ng/ml/h, mean +/- SD, p = 0.0058) whereas no difference was found among non diabetic siblings (24+/-14 vs. 22+/-11 ng/ml/h, NS). Our data confirm that plasma prorenin is elevated in NIDDM patients, and show: 1. that the raise of plasma prorenin in non-NIDDM siblings of a diabetic patient does not depend entirely from the presence of diabetes, and 2. that plasma prorenin in NIDDM probands and their concordant siblings goes along with micro-macroalbuminuria.     

Spironolactone treatment in patients with diabetic microalbuminuria and resistant hypertension

Resistant hypertension is common in diabetes. Spironolactone by inhibiting aldosterone not only exerts antihypertensive effect but also antiproteinuric effect. In this study, the mean decrease in systolic and diastolic blood pressure after 4?weeks of spironolactone was 25.5?±?7.8 and 11.4?±?3.5?mmHg respectively and it increased further at 8?weeks and at 12?weeks, while there was no significant change in blood pressure in the control group. At 12?weeks, significantly greater reductions in both the systolic and diastolic blood pressure were observed in patients treated with spironolactone having serum potassium less than 4?meq/l vs those having serum potassium more than 4?meq/l. Reduction in urine microalbumin, though higher in patients with serum potassium less than 4?meq/l was not significant at any intervals.     

Increase of activity of angiotensin-converting enzyme in insulin-dependent diabetic patients with permanent microalbuminuria]

Angiotensin I Converting Enzyme (ACE), which is synthesized by vascular endothelial cells, can be elevated in some diabetic subjects. To study if serum ACE can be elevated in subjects with high risk for malignant microangiopathy, 34 normotensive type I, insulin-dependent diabetic subjects with persistent microalbuminuria (30-300 mg/24 h) were compared for serum ACE activity (Liebermann's method) with 30 normotensive, normoalbuminuric type I, insulin-dependent diabetic subjects of same age (33 +/- 15 (M +/- SD) vs 39 +/- 14 years), sex (13 F/21 M vs 15 F/15 M), stage of retinopathy (14 vs 16 nil/11 vs 7 background/6 vs 4 preproliferative/3 vs 3 proliferative), HbA1c (7.7 +/- .9 vs 8.2 +/- 1.0%). Serum ACE activity of diabetic subjects were also compared with 120 age and sex related healthy controls. Serum ACE activity was higher in type I, insulin-dependent diabetic subjects with microalbuminuria than in those with normoalbuminuria (406 +/- 114 vs 359 +/- 97 IU/l; p = 0.05), or in controls (307 +/- 95 IU/l; p = 0.0001). Normoalbuminuric subjects also had higher ACE activity than controls (p = 0.02). In diabetic subjects, serum ACE activity was not related to diabetes duration (r = 0.1; ns), stage of retinopathy (r = 0.06; ns), HbA1c (r = 0.02; ns), or to blood pressure (r = 0.03; ns), but was related to urinary albumin excretion (r = 0.28; p = 0.03) in diabetic subjects. However, stage of retinopathy was related to diabetes duration (r = 0.74; p = 0.0004) and to age (r = 0.42; p = 0.003) in these subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Enalapril and microalbuminuria in diabetic and non-diabetic hypertension

Nine patients with non-insulin-dependent diabetes mellitus (NIDDM) and ten non-diabetic patients with mild hypertension were treated with enalapril 20 mg daily. None had overt nephropathy, though 4 diabetic subjects had microalbuminuria. Subjects with the highest baseline albumin excretion rates (AER) showed the greatest fall on therapy. Metabolic control of diabetes did not deteriorate. Enalapril had no significant effect on AER in NIDDM patients with AER below 20 micrograms/minute or in the non-diabetic group.     

The incidence of gastric and thyroid autoimmunity in insulin-dependent greek diabetic patients

The prevalence of antibodies against parietal cell cytoplasm, intrinsic factor, and thyroid cell cytoplasm was studied in 500 insulin-dependent Greek diabetics and 300 normal control subjects. All three antibodies were found to be significantly increased in the diabetic group. The incidence of antibodies increased with age and was higher in female diabetics. Greek diabetic patients have an incidence of intrinsic factor antibody similar to that found in other European diabetics but higher than that reported in Indian diabetics.     

依那普利对糖尿病者肾血流动力学及尿白蛋白的影响

本文比较了２８例老年糖尿病合并微白蛋白尿患者服依那普利（ｅｎａｌｐｒｉｌ）４周前后尿微量白蛋白、血及尿β２－微球蛋白、肾小球滤过率（以内生肌酐清除率表示）等变化。结果显示服药后尿微白蛋白排泄减少、内生肌酐清除率下降；将２８例分成正常（尿白蛋白＜２５ｍｇ／２４ｈ）及亚临床微白蛋白尿组（２５～１００ｍｇ／２４ｈ），发现前组服药后尿白蛋白排泄率无变化，而后组明显减少；按内生肌酐清除率将２８例分成正常组（＜１２０ｍｌ／ｍｉｎ）和升高组（＞１２０ｍｌ／ｍｉｎ），发现前组服药后内生肌酐清除率无改变，而后组明显降低。因此依那普利对老年糖尿病伴有尿微白蛋白和（或）内生肌酐清除率升高患者的肾脏有更明显的保护作用。     

Plasma beta-thromboglobulin and platelet factor 4 are not increased in insulin-dependent diabetic patients with microalbuminuria

To evaluate the possibility that platelet dysfunctions contribute to the cardiovascular risk of microalbuminuric insulin-dependent diabetic (IDD) patients, we have measured beta-thromboglobulin (BTG) and platelet factor 4 (PF4) in 74 IDD patients with different degrees of albuminuria (8 macro-, 36 micro- and 30 normoalbuminuric) and in 30 non-diabetic control subjects. BTG values (20.4±1.5 SEM in normo-, 22.2±1.2 in micro-, 101.1±2.9 in macroalbuminuric patients and 21.8±1.1 IU/ml in control subjects) were significantly higher (P<0.001) in the macroalbuminuric patients, but similar among the other groups. These results suggest that platelet hyperactivation is not present in the microalbuminuric stage of diabetic nephropathy, only in overt nephropathy.     

Lipids and diabetic nephropathy: hypertension,microalbuminuria and lipids in type 2 diabetic patients

Hypertension and microalbuminuria are predictors of cardiovascular mortality in type 2 (non-insulin-dependent) diabetes independently of other conventional risk factors. The presence of high triglyceride levels with small and/or dense low density lipoprotein particles is associated with cardiovascular disease. The aim of this study was to analyse the plasma lipids, Na⁺/Li⁺ countertransport (a genetic marker of hypertension) and microalbuminuria in type 2 diabetic patients. Plasma lipids were determined in 15 normotensive normoalbuminuric (H^–M^–), 32 hypertensive normoalbuminuric (H⁺M^–) and 22 hypertensive microalbuminuric (H⁺M⁺) type 2 diabetic patients and in 20 sex-and age-matched non-diabetic subjects. Plasma cholesterol was significantly higher in H⁺M⁺ patients than in controls (226±38 vs 192±38 mg/dl, mean ±SD). Plasma triglycerides were significantly higher in H⁺M⁺ patients than in either controls or H^–M^– patients (192±117 vs 104±59 and 115±52 respectively). The Na⁺/Li⁺ countertransport activity in red blood cells was significantly higher in H⁺M^– and H⁺M⁺ patients than in controls, and in the type 2 diabetic patients it was directly related to plasma triglycerides (r=0.53,P<0.0001) and inversely to high density lipoprotein (HDL) cholesterol (r=–0.43,P<0.0001). Microalbuminuria, hypertension and elevated Na⁺/Li⁺ countertransport activity are thus associated with high triglyceride and low HDL cholesterol levels in type 2 diabetic patients. This atherogenic lipoprotein pattern might at least partially explain the association of microalbuminuria with cardiovascular disease in type 2 diabetes.     

Urinary excretion of retinol-binding protein in type 1 (insulin-dependent) diabetic patients with microalbuminuria and clinical diabetic nephropathy

The urinary excretion of retinol-binding protein (RBP) was studied in 101 insulin-dependent diabetic patients allocated to three groups according to 24-h urinary albumin excretion rate (UAE) (median of three urine collections): group 1 (n=45), normal UAE<30 mg/24h; group 2 (n=27), microalbuminuria (UAE 30–300 mg/24 h); and group 3 (n=29), clinical diabetic nephropathy (UAE>300 mg/24 h). We used 23 healthy subjects as controls. Fractional clearance of RBP (FC-RBP) and its 24-h urinary excretion rate (URBP) were higher in each diabetic group than in healthy subjects, the highest values being found in group 3. Groups 1 and 2 did not differ in URBP and FC-RBP. There was a correlation between FC-RBP and haemoglobin A1c in both the total diabetic cohort (P<0.001) and in diabetic patients in groups 1 and 2 with a glomerular filtration rate of more than 90 ml/min (P<0.05). No correlation was found between FC-RBP and UAE and/or duration of diabetes in any of the diabetic groups. We conclude that the increased urinary excretion of RBP, indicating proximal tubular dysfunction, is already present in normoalbuminuric insulindependent diabetic patients and correlates with metabolic control. Further deterioration in proximal tubular function was not observed in microalbuminuric patients, but is a late event in clinical diabetic nephropathy.     

Prevalence of hypertension and microalbuminuria in adult type 1 (insulin-dependent) diabetic patients without renal failure in Italy. I. Validation of screening techniques to detect microalbuminuria

The prevalence of microalbuminuria and arterial hypertension among type 1 (insulin-dependent) diabetic patients is poorly known in Italy. In the preliminary phase of a large outpatient screening programme, we addressed the possibility of using non-time urine samples to predit the chance of detecting albumin excretion rate (AER) in the range of microalbuminuria. We therefore measured urinary albumin and creatinine concentration in timed overnight collections from 641 type 1 diabetic patients with serum creatinine levels lower than 133 mol/l. AER was strongly and comparably predicted both by urinary albumin concentration (U_Alb;r ²=0.754) and by the urinary albumin to creatinine concentration ratio (A/C;r ²=0.773). After exploring several independent cut-off levels for U_Alb and A/C, AER in the range 20–200 g/min (n=91) was found to be predicted with 90% sensitivity and specificity either by U_Alb20 mg/l or by A/C2.0 mg/mmol. U_Alb was negatively associated with diuresis, and false negative outcomes were explained by polyuria when screening by this variable. A/C was positively associated with female gender among normoalbuminuric patients, in line with the lower urinary excretion of creatinine in women (7.2±0.25 vs 10.2±0.35 mol/min,P<0.00001). A significant excess of false positive outcomes in women compared with men was found when screening by any A/C cut-off level equal to or less than 2.5 mg/mmol. Simplified screening techniques seem to remain, however, a practicable option for the detection of microalbuminuria both in epidemiology and in clinical practice.See Appendix     

High incidence of silent myocardial ischemia in elderly patients with non insulin-dependent diabetes mellitus

The present study was designed to reveal the incidence of silent myocardial ischemia in asymptomatic elderly non-insulin-dependent diabetic (NIDDM) patients (aged over 60 years). As a first step screening, maximal treadmill exercise test was performed. Of 140 patients studied, 54 (38.6%) were unable or not expected to achieve diagnostic levels of exercise during treadmill testing. A positive exercise test was noted in 39 of 86 (45.3%) subjects. As a second step examination, dipyridamole thallium scintigraphy was performed for 93 subjects who exhibited a positive exercise test and could not perform a maximal exercise test. Abnormal perfusion pattern was found in 39 of 93 (41.9%), who were finally considered to have a silent myocardial ischemia. Coronary angiography was performed in 18 subjects with diagnosis of silent myocardial ischemia, who gave their consent. Significant coronary artery stenosis was in fact found in 17 of 18 (94.4%) subjects studied, confirming a very high positive predictive value of this diagnostic procedure. In conclusion, elderly NIDDM patients (aged over 60 years) had an extremely high prevalence (estimated 26.3%) of silent myocardial ischemia. This evidence suggests that early and intensive detection may be needed as a part of routine care for this group.     

Alterations in serum lipids and apolipoproteins in male Type 1 (insulin-dependent) diabetic patients with microalbuminuria

Summary The relationships between serum lipid, apolipoprotein levels and urinary albumin excretion were investigated in 20 male Type 1 (insulin-dependent) diabetic patients with microalbuminuria (overnight urinary albumin excretion between 10 and 200 g/min), in 18 male Type 1 diabetic patients without microalbuminuria and in 18 male control subjects. In the microalbuminuric patients low density lipoprotein cholesterol was higher than in the control subjects (p<0.05); the high density lipoprotein/low density lipoprotein cholesterol ratio was lower than in the normoalbuminuric diabetic patients (p<0.05), and in the control subjects (p<0.01); apolipoprotein B was higher than in the normoalbuminuric patients (p<0.05); the apolipoprotein A₁/B ratio was lower than in the normoalbuminuric diabetic patients (p<0.05). Serum triglyceride was higher in the microalbuminuric diabetic patients and in the control subjects than in the normoalbuminuric diabetic patients (p<0.05, for both), but was not different between the microalbuminuric diabetic patients and the control subjects. No significant differences between the 3 groups were present with respect to serum cholesterol, high density lipoprotein cholesterol and apolipoprotein A₁. In the 2 combined Type 1 diabetic groups there were significant correlations between urinary albumin excretion and the high density lipoprotein/low density lipoprotein cholesterol ratio (R -0.40, p<0.02), apolipoprotein B (R0.35, p<0.05) and the apolipoprotein A₁/B ratio (R -0.44, p<0.01). These results indicate microalbuminuria related differences in lipid and apolipoprotein levels in male Type 1 diabetic patients, which may contribute to an increased risk of cardiovascular disease.     

中国内地2型糖尿病合并高血压患者微量白蛋白尿检出率调查

目的调查内分泌科及心内科门诊中糖尿病合并高血压患者微量白蛋白尿（MA）检出率。方法多中心连续收集2型糖尿病合并高血压患者共2473例,采用统一调查表记录患者糖尿病、高血压控制情况及相关并发症,测量血压。采用Micral-Ⅱ试纸半定量比色法筛查尿微量白蛋白。结果2型糖尿病合并高血压患者MA的检出率为42．9％,大量白蛋白尿检出率17．0％。多因素回归分析显示,患者年龄、收缩压水平、空腹血糖水平以及BMI与糖尿病合并高血压患者MA的发生独立相关;除上述因素外,尚有糖尿病病程、应用利尿剂与大量白蛋白尿的发生独立相关。结论在2型糖尿病合并高血压患者中MA检出率极高,MA筛查及强力降压治疗甚为重要。     

Increased transcapillary escape rate of albumin in Type 1 (insulin-dependent) diabetic patients with microalbuminuria

Summary The transcapillary escape rate, intravascular mass and outflux of albumin were measured in 75 Type 1 (insulin-dependent) diabetic patients. The groups were defined as: group 1: normal urinary albumin excretion, <30 mg/24 h (n=21); group 2: microalbuminuria, 30–300 mg/24 h (n=36); group 3: diabeticnephropathy, <300 mg/24 h (n=18). Fifteen sex- and age-matched non-diabetic persons served as control subjects. The diabetes duration was: group 1: 20±9 years, group 2: 17±5 years, group 3: 19±7 years. The transcapillary escape rate of albumin was similar in controls and group 1 (5.0±1.8 versus 5.2±1.5%) and was significantly higher in the microalbuminuric group 2 and group 3 (8.1±2.2 versus 8.1±2.3 %). The differences were not explained by differences in metabolic control or blood pressure at the time of investigation. The outflux of albumin was also higher in group 2 than in group 1 and controls (7.1 ± 2.0 versus 5.3±1.5 and 5.1±2.0 g/h × 1.73 m²). It was indistinguishable from controls in group 3 (5.8±1.5 g/h × 1.73 m²) because of a reduced intravascular mass of albumin (p<0.01) in group 3. In conclusion, a universal vascular leakage of albumin is an early event in the development of diabetic nephropathy, with the leakage of albumin being fully developed in the microalbuminuric patient. In contrast, long-term diabetic patients with normal urinary albumin excretion have a normal transcapillary escape rate of albumin.     

Early glomerulopathy is present in young,Type 1 (insulin-dependent) diabetic patients with microalbuminuria

Summary Increased urinary albumin excretion, microalbuminuria, may be the first sign of early diabetic nephropathy. We examined glomeruli by morphometric methods in 17 patients with Type 1 (insulin-dependent) diabetes mellitus and microalbuminuria. The median age was 19 (range 18–29) years, duration of diabetes 12 (8–15) years, mean blood pressure 93 (87–115) mm Hg, glomerular filtration rate 132 (101–209) ml·min⁻¹·1.73 m²⁻², albumin excretion rate (mean over 1 year) 32 (15–194) μg/min. Reference data were obtained from 11 healthy kidney donors. Mesangial volume estimates were obtained by serial sectioning in three total profiles in each of three glomeruli in diabetic patients. Basement membrane thickness and matrix volume fraction were estimated from one level per glomerulus. Two matrix parameters, matrix star volume and matrix thickness, were estimated. Interstitial volume fraction in cortex was measured by light microscopy. The morphological parameters were significantly increased in the diabetic group compared to the control group, basement membrane thickness (mean with 95% confidence intervals) was 595 nm (549–641 nm) vs 305 nm (287–325 nm),p=0.0001; mesangial volume fraction 0.22 (0.21–0.23) vs 0.19 (0.18–0.21),p=0.04, and matrix volume fraction 0.13 (0.12–0.13 vs 0.09 (0.08–0.10),p=0.001. Also matrix star volume and thickness, interstitial volume fraction and mean capillary diameter were significantly increased. The intra-individual variation among glomeruli expressed as coefficient of variation was 7.4% vs 9% (basement membrane thickness) and 11.7% vs 25% (mesangial volume fraction) in the diabetic and the control group, respectively. Increment of basement membrane thickness and matrix volume fraction per year were significantly correlated with mean 1-year HbA_lc (r=0.55 andr=0.51, respectively). We conclude that microalbuminuria in Type 1 diabetes is associated with increased basement membrane thickness and also mesangial matrix expansion. This increment seems to correlate with glycaemic control.     

糖尿病合并高血压对微血管病变患病率的影响

目的　为了解糖尿病合并高血压对微血管病变患病率的影响。方法　对３２５ 例２ 型糖尿病合并与不合并高血压对糖尿病微血管病变患病率的影响进行了回顾性分析。结果　２ 型糖尿病合并高血压组糖尿病肾病（ Ｄ Ｎ） 、糖尿病视网膜病变（ Ｄ Ｒ） 、糖尿病周围神经病变（ Ｄ Ｐ Ｎ） 和糖尿病自主神经病变（ Ｄ Ａ Ｎ） 的患病率分别为６１ ．３２ ％ 、４９ ．０６ ％ 、４５ ．２８ ％ 和２４ ．５３ ％ ，均高于血压正常组（ 患病率分别为２７ ．８５ ％ 、２９ ．６８ ％ 、３２ ．４２ ％ 和１５ ．５３ ％ 。有关影响因素拟合 Ｌｏｇｉｓｔｉｃ 逐步回归方程分析，结果显示糖尿病病程是 Ｄ Ｎ、 Ｄ Ｒ、 Ｄ Ｐ Ｎ 和 Ｄ Ａ Ｎ 患病的共同影响因素。高血压是 Ｄ Ｎ、 Ｄ Ｐ Ｎ 患病的危险因素（ Ｏ Ｒ 值分别为２ ．５９ 、２ ．５５ ， Ｐ 值分别为＜ ０ ．０１ 、＜ ０ ．０５） 。结论　糖尿病合并高血压将增加糖尿病微血管病变的患病率。     

A nationwide cross-sectional study of retinopathy and microalbuminuria in young Norwegian Type 1 (insulin-dependent) diabetic patients

Summary A nationwide cohort of Type 1 (insulin-dependent) diabetic patients was studied to determine the prevalence of retinopathy and microalbuminuria and to evaluate the association to various risk factors. Of 600 subjects with mean age of 19.8 years (range 8.0–30.3) and a mean duration of diabetes of 10.5 years (range 6.2–17.3),371 (60 %) volunteered for a clinical examination which included fundus photography, timed overnight urine samples for albumin excretion rate, measurement of arterial blood pressure and determination of HbA_1c, Retinopathy was found in 122 of 371 patients (32.8 %), in 3 of 41(7.3 %) patients aged less than 13 years. The youngest subject with retinopathy was 9.6 years old. Microalbuminuria was found in 44 of 351 patients (12.5 %), in 1 of 41(2.4 %) patients aged less than 13 years. The youngest subject with microalbuminuria was 11.5 years old. Mean HbA_1c was 8.6 % (normal range 4.5–6.1 %). Patients with retinopathy had significantly higher mean age (p = 0.0001), longer mean duration of diabetes (p = 0.0001), higher mean HbA_1c (p = 0.009), and higher mean arterial blood pressure (p = 0.0001) compared to patients without retinopathy. In microalbuminuric patients HbA_1c (p =0.0001) and mean arterial blood pressure (p = 0.01) were significantly higher compared to non-microal-buminuric patients, but there was no difference in age or diabetes duration. Ina multiple logistic regression model, age, HbA, duration of diabetes and mean arterial blood pressure were found to be significantly associated with retinopathy, while HbA_1c mean arterial blood pressure and onset before 13.0 years of age were found to be associated with microalbuminuria. The prevalence of retinopathy and microalbuminuria was relatively low. Both retinopathy and microalbuminuria were strongly associated with blood glucose control and developed at prepubertal age in some patients. The findings indicate that more intense optimization of blood glucose control in children and adolescents with Type 1 diabetes is warranted.