The Course of Incipient and Overt Diabetic Nephropathy: The Perspective of Insulin Pump Treatment
The long-term objective of insulin treatment of insulin-dependent diabetes mellitus (IDDM) is prevention of late complications. Although never directly proven, it has been a widely accepted hypothesis that development of such microvascular complications is, at least in part, due to the lack of good metabolic control [1, 2]. Since the capacity of most diabetes clinics is at present too small to cope with the enormous task of normalizing or nearly normalizing the metabolic control in all patients, many compromises defining good or acceptable metabolic control have been made while awaiting more rigorous testing of the hypothesis. This testing again had to await the introduction of more intensive treatment regimens, such as multiple insulin injections (injection pens) or insulin infusion pumps combined with new techniques for home blood glucose monitoring. During such regimens, an improved and often “near normal” blood glucose level can be maintained for long periods as documented by measurement of glycosylated hemoglobin, an index of the longterm level of the glycemic control [3–8]. A number of studies, retrospective and prospective, taking advantage of these techniques, have been performed. When reviewing these studies, the general interpretation is that the blood glucose level is in fact important for the development and progression of diabetic microangiopathy in humans .
KeywordsDiabetic Nephropathy Urinary Albumin Excretion Continuous Subcutaneous Insulin Infusion IDDM Patient Conventional Treatment Group
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