Microangiopathic complications in type 1 diabetes mellitus
differences in severity when isolated or associated with autoimmune polyendocrinopathies
Keywords:
Microangiopathy, Type 1 diabetes mellitus, Autoimmune poliendocrinopathiesAbstract
CONTEXT: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease. OBJECTIVE: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1). PATIENTS: OSAD (n=17) and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 ± 8.2 and 13.2 ± 5.9 years, respectively) and metabolic control (HbA1c: 6.4 ± 1.9 and 6.8 ± 1.4%). MAIN OUTCOME MEASURES: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. RESULTS: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 ± 2.5 vs. 17.3 ± 9.2 µg/min; p< 0.05). Nephropathy was detected in 12% of the OSAD (none of them macroproteinuric) and in 39% of the iDM1 . The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p< 0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29% of the OSAD and in 46% of the iDM1. CONCLUSIONS: OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1 , the increase in UAE of OSAD was not associated with reductions in GFR.
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Orchard TJ, Dorman JS, Maser RE, et al. Prevalence of complications in IDDM by sex and duration. Diabetes 1990;39:1116-24.
Kostraba JN, Dorman JS, Orchard TJ, et al. Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects. Diabetes Care 1989;12:686-93.
Karjalainen J, Salmela P, Ilonen J, Surcel H-M, Knip M. A comparison of childwood and adult type I diabetes mellitus. N Engl J Med 1989;320:881-6.
Parving HH, Andersen AA, Smidt UM, Svendensen PA. Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1983;1:1175-9.
Osterby R, Parving HH, Nyberg G, Hommel E, Mauer SM, Steffes MW. Morphology of diabetic glomerulopathy and relationship to hypertension. Diab Metab 1989;15:278-83.
Borch-Johnsen K, Norgaard K, Hommel E, et al. Is diabetic nephropathy an inherited complication? Kidney International 1992;41:719-22.
Billaut BM, Passa PL. Factors associated with diabetic microangiopathy: a study of 157 type I (insulin dependent) diabetic patients. J Diabetic Complications 1991;5(4):238-43.
Dahl-Jorgensen K, Bjoro T, Kierulf P, Sandvik L, Bangstad HJ, Hanssen KF. Long-term glycemic control and kidney function in insulin-dependent diabetes mellitus. Kidney International 1992;41:920-3.
The diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes. N Engl J Med 1993;329:977-86.
Vibert GC, Earle K. Predisposition to essential hypertension and the development of diabetic nephropathy. J Am Soc Nephrol 1992;3:S27-S33.
Krolewski AS, Canessa M, Warram JH, et al. Predisposition to hypertension and susceptibility to renal disease in insulin-dependent diabetes mellitus. N Engl J Med 1988;318:140-5.
Eff C, Faber O, Deckert T. Persistent insulin secretion assessed by plasma C-peptide estimation in long term juvenile diabetes with a low requirement. Diabetologia 1978;15:169-72.
Sjoberg S, Sjotterberg M, Berglund L, Moller E, Ostman J. Residual C-peptide excretion is associated with a better long term control and slower progress of retinopathy in type I diabetes mellitus. J Diabetic Complications 1991;5(1):18-22.
Allen C, Zaccaro DJ, Palta M, Klein R, Duc SC, Dalessio DJ. Glycemic control in early IDDM. Diabetes Care 1992;15(8):980-7.
Carpenter CCJ, Solomon N, Silverberg SG, et al. Schmidt's syndrome (thyroid and adrenal insufficiency): a review of literature and a report of fifteen new cases including ten instances of coexistent diabetes mellitus. Medicine 1964;43:153-80.
McKenna MJ, Herskowitz R, Wolfsdorf JI. Screening for thyroid disease in children with IDDM. Diabetes Care 1990;13:801-3.
Landin-Olsson M, Karlsson FA, Lernmark A, Sundkvist G. The diabetes incidence in Sweden study group: islet cell and thyrogastric antibodies in 633 consecutive 15- to 34-yr-old patients in the diabetes incidence study in Sweden. Diabetes 1992;41:1022-7.
Rabinowe SL, Eisenbarth GS. Polyglandular autoimmunity. Year Book Medical Publishers Inc. 1986;203-307.
Muir A, Noel KM. Autoimmune diseases of the adrenal glands, gonads and hypothalamic-pituitary axis. Endocrin Met Clin NA 1991;20(3):619-44.
Madsbad S. Prevalence of residual b cell function and its metabolic consequences in type I diabetes. Diabetologia 1983;24:141-6.
Klaff L, Tamborlane WV, Clearly PA, et al. The DCCT group: effects of age, duration and treatment of insulin-dependent diabetes mellitus on residual b-cell function: observations during elegibility testing for the diabetes control and complications trial (DCCT). J Clin Endocrinol Metab 1987;65:30-6.
The National Data Group, National Institute of Health (NIH): Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;18:1039-57.
Diabetic Retinopathy Research Group. Report number 7: a modification of the Airlie House classification of diabetic retinopathy. Invest Ophthalmol Vis Sci 1981;21:210-26.
De Sá JR, Russo EMK, Miranda WL, et al. Comparaçăo entre os métodos de cromatografia de troca iônica e cromatografia de afinidade para a dosagem de hemoglobina glicosilada (HbA1). Arq Bras Endocr Metab 1987;31:1-3.
Engvall E, Rvoslahtt E. Principles of ELISA and recent applications to the study of molecular interactions. In: Nakamura RM, Dito WR, Tucker ES, Alan R, editors. Immun clin lab. New York: Liss Inc 1979;89-97.
Mogensen CE. Microalbuminuria and incipient diabetic nephropathy. Diab Nephropathy 1984;3:75-8.
Vibert GC, Wiseman MJ. The kidney in diabetes: significance of the early abnormalities. Clin Endocrinol Metab 1986;15:753-82.
Rutherford WE, Blondin J, Miller JP, Greenwalt AS, Varva JD. Chronic progressive renal disease: rate of change of serum creatinine concentration. Kidney Int 1977;11:62-70.
Nagaoka K, et al. Thyroglobulin and microsomal antibodies in thyroid disease. Treasure Box of Internal Medicine 1975;22:119.
Yoshida H, et al. Association of serum antithyroid antibodies with lymphocytic infiltration of the thyroid gland: studies of serum autopsied cases. J Clin Endocrinol Metab 1978;46(6):859.
Bottazzo GF, Mann JI, Thorogood M, Baum JD, Doniach D. Autoimmunity in juvenile diabetes and their families. BMJ 1978;2:165-8.
Gray RS, Clarke BF. Comparison of retinopathy in insulin-dependent diabetics with and without thyroid diseases. BMJ 1979;17:590.
Hanssen KS, Bangstad HJ, Brinchman-Hanssen O, Dahl-Jorgensen K. Glycemic control, incipient diabetic nephropathy, and diabetic retinopathy. J Diabetic Complications 1990;4(2):66-7.
Brinchman-Hanssen O, Dahl-Jorgensen K, Sandvik L, Hanssen KF. Blood glucose concentrations and progression of diabetic retinopathy: the seven year results of the Oslo study. BMJ 1992;304:19-22.
Zanella MT, Freire MBS, Milagres R, Ferreira SR, Bonomo PP, et al. Blood pressure disturbances in diabetes mellitus. J Hypertension 1992;10(suppl 7):S59-S70.
Cruickshanks KJ, Vadheim CM, Moss SE, Roth M-P, Riley WJ, Maclaren NK, et al. Genetic marker associations with proliferative retinopathy in persons diagnosed with diabetes before 30 yr of age. Diabetes 1992;41:879-85.
Bosi E, Becker F, Bonifacio E, Wagner R, Collins P, Gale AM, Bottazzo GF. Progression to type I diabetes in autoimmune endocrine patients with islet cell antibodies. Diabetes 1991;40:977-84.
Parving HH, Hommel E, Mathiesen E, et al. Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. BMJ 296:156-60.
Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR. Risk of proliferative diabetic nephropathy in juvenile-onset type I diabetes: a 40-yr follow-up. Diabetes Care 1986;9:443-52.
Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T. Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study. Diabetologia 1983;25:496-501.
Krolewski AS, Warram JH, Christlieb AR, Busik EJ, Kahn CR. The changing natural history of nephropathy in type I diabetes. Am J Med 1985;78:785-94.
Cottini E, Finkielman S, Nahmod VE. Diabetes e hipertension, asociacion letal. Medicina 1991;51(4):5-377.
Parving HH. The impact of hypertension and antihypertensive treatment on the course and prognosis of diabetic nephropathy. J Hypertension 1990;8 suppl 7:S187-91.
Parving HH, Oxenbool B, Svendsen PA, Sandhal-Christiansen J, Anderson AL. Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion. Acta Endocrinol 1982;100:550-5.
Tsalamandris C, Allen TJ, Gilbert RE, Sinha A, Panagiotopoulos S, Cooper ME, Jerums G. Progressive decline in renal function in diabetic patients with and without albuminuria. Diabetes 1994;43:649-55.
Maclaren NK, Riley WJ. Inherited susceptibility to autoimmune Addison's disease is linked to human leucocitary antigen DR3 and/or DR4, except when associated with type I autoimmune polyglandular syndrome. J Clin Endoc Metab 1986;62(3):55-459.
Eisenbarth G, Wilson P, Ward F, Lebovitz E. HLA type and occurence of disease in familial polyglandular failure. N Engl J Med 1978:92-4 (Jan 12).
Freedman BI, Heise E, Canzanello VJ. Diabetic neuropathy and HLA-DR3/4. Ann Int Med 1982;117(5):445.
Wilkin TJ. Antibody markers in predicting type I diabetes: a review. J Royal Soc Med 1990;83:632-6.
Peig M, Gomis R, Ercilla G, Casamitjana R, Bottazzo GF, Pujol-Borrell R. Correlation between residual b-cell function and islet cell antibodies in newly diagnosed type I diabetes. Diabetes 1989;38:1396-401.
Bottazzo GF, Florin-Christensen A, Doniach D. Islet cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiences. Lancet 1974;2:1279-83.
Kobayashi T, Tamemoto K, Nakanishi K, Kato N, Okubo M, Kajio H, et al. Immunogenetic and clinical characterization of slowly progressive IDDM. Diabetes Care 1993;16(5):780-8.
Zavala AV, de Bruno LEF, Cardoso AI, Mota AH, Capucchio M, Poskus E, et al. Cellular and humoral autoimmunity markers in type II (non-insulin dependent) diabetic patients with secondary drug failure. Diabetologia 1992;35:1159-64.
Groop L, Bottazzo GF, Doniach D. Islet cell antibodies identify latent type I diabetes in patients aged 35-75 at diagnoses. Diabetes 1996;39:237-41.
