ISSN:
1432-0428
Keywords:
Type 2 diabetes
;
microvascular complications
;
proteinuria
;
albuminuria
;
hypocaloric diet
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary To determine whether sustained control of hyperglycaemia in Type 2 (non-insulin-dependent) diabetic patients would diminish proteinuria, the effect of hypocaloric diet therapy (500 kcal/day) on proteinuria was assessed in obese, Type 2 diabetic patients (n=24) and compared with results obtained for obese subjects with normal glucose tolerance (n=7) and impaired glucose tolerance (n=6). Diet therapy of similar mean duration resulted in similar percentage weight loss (mean percentage of original weight ±SEM) in diabetic (13.6±1.6%), glucose intolerant (16.4±3.3%) and obese nondiabetic (11.0±1.0%) subjects. Following therapy, plasma glucose concentrations 2h after an oral glucose load declined in the diabetic (18.34±0.81 to 10.67±0.50 mmol/1, mean ±SEM; p〈0.001) and in the glucose intolerant subjects (10.2±0.3 to 7.3±0.4 mmol/l, p〈0.01) while remaining unchanged in the obese non-diabetic subjects (7.09±0.23 to 6.77±0.32 mmol/l, NS). Concentrations of total protein of plasma origin and albumin in 24-h urine collections were quantified by a sensitive immunonephelometric assay using specific antisera. Initially, 24-h excretion of total protein and albumin were elevated in the diabetic [mg protein/24 h; (median±95% confidence limits): 63 (42–138), p〈0.05; albumin: 26 (14–56), p〈0.05] and glucose intolerant subjects [protein:52 (13–92), NS; albumin: 24 (3–61), NS] compared with the non-diabetic subjects [protein: 20 (5–38); albumin: 6.2 (3.5–9.5)]. Following diet therapy, both total protein and albumin excretion were reduced significantly in diabetic subjects (p〈0.001) and similar decreases were observed in clearance rates of protein and albumin. Initially, 11 out of the 24 diabetic subjects had 24-h albumin excretion in the subclinical range (〉30, 〈 500 mg/24h), whereas following diet therapy, only three out of the 11 had subclinical albuminuria. For all subjects, the decrease in albumin excretion following diet therapy was significantly correlated with the initial albumin excretion (r=0.63, p〈0.0001). In one diabetic subject, whose glucose tolerance and albumin excretion were sequentially monitored for 14 months, the decreases in glycaemia and proteinuria observed in the first month of therapy persisted after discontinuation of diet therapy. Thus, metabolic control of Type2 diabetes by a hypocaloric diet produced significant sustained reductions in proteinuria. The question remains whether or not this retards the development of clinical nephropathy or end stage renal disease.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF00281119
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