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  • Articles: DFG German National Licenses  (2)
  • 1990-1994  (2)
  • Key words IDDM, nerve conduction velocity, neuropathy, intensified insulin treatment.  (1)
  • microalbuminuria  (1)
  • 1
    ISSN: 1432-0428
    Keywords: Key words IDDM, nerve conduction velocity, neuropathy, intensified insulin treatment.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have investigated the effect of long-term strict glycaemic control on peripheral and autonomic nerve function in 45 IDDM patients (age 18–42 years, diabetes duration 7–23 years) without clinical signs of neuropathy or other neurological disease. They were randomly assigned to treatment either with continuous insulin infusion, multiple injections (4–6 times daily), or conventional treatment (twice daily) for 4 years and followed prospectively for 8 years. Motor and sensory nerve conduction velocities were measured at the start and after 8 years. Autonomic nerve function tests were performed only once, after 8 years. A significant reduction of nerve conduction velocity was observed during 8 years in patients with mean HbA1 more than 10 % (n =12, group mean 10.9 %, range 10.1–13.2 %) compared to patients with HbA1 less than 10 % (n =33, group mean 9.0 %, range 7.5–9.9 %). Change of motor nerve conduction velocity in the peroneal nerve was: –4.8±4.9 (SD) vs –2.2±5.3 m/s (p〈0.01). Change of motor nerve conduction velocity in the posterior tibial nerve was: –6.8±5.7 vs –3.9±5.1 m/s (p〈0.05). No significant changes were observed in the ulnar nerve. Change of sensoric nerve conduction velocity in the sural nerve was: –8.9±8.0 vs –4.6±5.3 m/s (p〈0.05). Multiple regression analysis showed that a change in HbA1 of 1 % resulted in a 1.3 m/s change in nerve conduction velocity during 8 years. A significantly lowered heart-rate variation during deep breathing (p〈0.05) and heart-rate response to standing (p〈0.01) was found in patients with HbA1 more than 10 % compared to patients with HbA1 less than 10 %. This study confirms that the long-term lowering of blood glucose retards the deterioration in nerve conduction velocity observed in the diabetic nerve. [Diabetologia (1994) 37: 579–584]
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes mellitus ; nephropathy ; microalbuminuria ; continuous subcutaneous insulin infusion ; metabolic control ; glomerular charge selectivity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We first compared glomerular charge selectivity index in two matched groups of Type 1 (insulin-dependent) diabetic patients with micro and normoalbuminuria respectively, and secondly, investigated prospectively in a randomized clinical trial, the influence of improved metabolic control on selectivity index in diabetic patients with microalbuminuria. In Study 1, 27 patients with microalbuminuria (albumin excretion 〉-15 μg/min in at least two out of three overnight urine samples) were matched (age, diabetes duration, mean 1-year HbA1c, gender) with normoalbuminuria patients (n=24), and in Study 2, 23 microalbuminuric patients were randomly allocated to either intensive (continuous subcutaneous insulin infusion) or conventional treatment. Glomerular charge selectivity index was measured as IgG/IgG4 selectivity index, i.e. total IgG/IgG4 clearance ratio in timed overnight urine samples. The microalbuminuric patients had a significantly reduced selectivity index compared to the normoalbuminuric patients: 1.20 (0.92–1.40) vs 1.68 (1.22–2.21), median and 95% confidence interval (p〈0.01). In Study 2, the HbA1c improved in the intensive-treatment group compared to the conventional-treatment group: at 2, 6 and 12 months the difference in mean percentage HbA1c between the groups was 1.1, 1.2 and 1.4, respectively (p〈0.01). A sharp 50% increment in IgG/IgG4 selectivity index was seen in the intensive-treatment group during the first 6 months (p〈0.05 compared to the conventional group). We conclude that adolescents and young adults in an early stage of diabetic nephropathy have reduced glomerular charge selectivity, which may be improved by reducing the mean blood glucose level.
    Type of Medium: Electronic Resource
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