Retrospective and prospective analysis of selected factors influencing the development of diabetic nephropathy
Maryna Krawczuk-Rybak, Jadwiga Peczyńska, Mirosława Urban
Med Sci Monit 1999; 5(2): CR289-295
The aim of study was to identyfy factors preceding and influencing further development of diabetic nephropathy,from normo- to microalbuminuria. Retrospective analysis was carried out in the group of 15 young subjects with diabetes type 1 aged mean 16.6 years, SD=1.34, and with persistent microalbuminuria which appeared in the age mean 14.9 years, SD=1.6 (i.e. in the period '-3', '-2', '-1' years preceding appearance of permanent microalbuminuria), and in the moment of its manifestation ('0'). Prospective evaluation of the following indices was also carried out (about 2 years after appearance of microalbuminuria -'+1'): body mass index (BMI), arterial pressure values, 24-hour doses of insulin/kg of body mass, glycemic control (HbA1c), lipid balance. The control group included 13 patients of approximate age with diabetes of approximate duration without symptoms of microangiopathy.
Results: 1. Systolic arterial pressure was higher in the examined group as compared to the control group in the time of manifestation of microalbuminuria ('0') and diastolic arterial pressure - in the period '-3'. The analysis did not show differences in other periods. 2. Values of HbA1c and 24-hr dose of insulin/kg of body mass were higher in all periods of the analysis. 3. No differences in BMI were observed. 4. Values of total cholesterol did not show differences, but values of triglycerides were higher in retrospective analysis.
Conclusion: Appearance of permanent microalbuminuria is preceded by long-term incorrect glycemic control, administration of higher doses of insulin and tendency to higher values of triglycerides.
Keywords: dyslipidaemia, diabetic nephropathy, insulin-dependent diabetes