The Course of Incipient and Overt Diabetic Nephropathy: The Perspective of More Optimal Insulin Treatment

  • Bo Feldt-Rasmussen


The long-term objective of insulin treatment of insulin dependent diabetes mellitus (IDDM) is prevention of late complications. Through the years it has been a widely acceptedhypothesis that development of such microvascular complications should be, at least in part, due to the lack of good glycemic control. This hypothesis has been unduely hard to prove but results from a number of small scaled interventionstudies and the result of the larger scaled American Diabetes Control and Complication Trial (DCCT) has now decisively documented, that development and progression of diabetic complications is closely associated with poor glycemic control. The design and outcome of a number of these studies will be presented and discussed in this chapter as will the practical consequences of this newly gained knowledge.


Glycemic Control Diabetic Nephropathy Continuous Subcutaneous Insulin Infusion Urinary Albumin Excretion Rate Insulin Dependent Diabetes Mellitus Patient 
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  1. 1.
    Rosenstock J, Raskin P. Early diabetic nephropathy: Assesment and potential therapeutic interventions. Diabetes Care 1986; 9: 529–545.PubMedCrossRefGoogle Scholar
  2. 3.
    Feldt-Rasmussen B. Microalbuminuria and clinical nephropathy in Type 1 (insulin-dependent), diabetes mellitus: Pathophysiological mechanisms and intervention studies (Thesis). Dan Med Bull 1989; 36: 405–415.PubMedGoogle Scholar
  3. 4.
    Jensen T. Albuminuria-a marker of renal and general vascular disease in IDDM (Thesis). Dan Med Bull 1991; 38: 134–144.PubMedGoogle Scholar
  4. 5.
    Mathiesen ER. Prevention of diabetic nephropathy: Microalbuminuria and perspectives for intervention in insulin-dependent diabetes (Thesis). Dan Med Bull 1993; 40: 273–285.PubMedGoogle Scholar
  5. 6.
    Christensen CK. The pre-proteinuric phase of diabetic nephropathy (Thesis). Dan Med Bull 1991; 38: 145–159.PubMedGoogle Scholar
  6. 7.
    Mogensen CE, Chacati A, Christensen CK, Close CF, Deckert T, Hommel E, Kastrup J, Lefebre P, Mathiesen ER, Feldt-Rasmussen B, Schmitz A, Viberti GC. Microalbuminuria: An early marker of of renal involvement in diabetes. Uremia Invest 1986; 9: 85–95.Google Scholar
  7. 8.
    Wang PH, Lau J, Chalmers TC. Meta-analysis of effects of intensive blood-glucose control on late complications of Type 1 diabetes. Lancet 1993; 341: 1306–1309.PubMedCrossRefGoogle Scholar
  8. 9.
    Hanssen KF, Dahl-Jørgensen K, Lauritzen T, Feldt-Rasmussen B, Brinchmann-Hansen O, Deckert T. Diabetic control and microvascular complications: The near-normoglycaemic experience. Diabetologia 1986; 29: 677–684.PubMedCrossRefGoogle Scholar
  9. 10.
    Lauritzen T, Frost-Larsen K, Larsen HW, Deckert T, Steno Study Group. Two years experience with continuous subcutaneous insulin infusion in relation to retinopathy and neuropathy. Diabetes 1985; 34 suppl 3: 74–79.PubMedCrossRefGoogle Scholar
  10. 11.
    Feldt-Rasmussen B, Mathiesen ER, Deckert T. Effect of 2 years of of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes. Lancet 1986; i: 1300–1304.CrossRefGoogle Scholar
  11. 12.
    Feldt-Rasmussen B, Mathiesen ER, Jensen T, Lauritzen T, Deckert T. Effect of improved metabolic control on loss of kidney function in insulin-dependent diabetic patients. Diabetologia 1991; 34: 164–170.PubMedCrossRefGoogle Scholar
  12. 13.
    Dahl-Jørgensen K, Hanssen KF, Kierulf P, Bjøro T, Sandvik L, Aagenaess Ø. Reduction of urinary albumin excretion after 4 years of continuous subcutaneous insulin infusion in insulin-dependent diabetes mellitus. Acta Endocrinol 1988; 117: 19–25.PubMedGoogle Scholar
  13. 14.
    Dahl-Lørgensen K, Bjøro T, Kierulf P, Sandvik L, Bangstad HJ, Hanssen KF. The effect of long-term stict glycemic control on kidney function in insulin-dependent diabetes mellitus: seven years result from the Oslo Study. Kidney Int 1992; 41; 920–923.CrossRefGoogle Scholar
  14. 15.
    Bangstad H-J, Østerby R, Dahl-Jørgensen K, et al. Early glomerulopathy is present in young Type 1 (insulin-dependent) diabetic patients with microalbuminuria. Diabetologia 1993; 36: 523–529.PubMedCrossRefGoogle Scholar
  15. 16.
    Reichard P, Berglund B, Britz A, Cars I, Nilsson BY, Rosenqvist U. Intensified conventional insulin treatment retards the microvascular complications of insulin-dependent diabetes mellitus (IDDM). The Stockholm Diabetes Intervention Study after five years. J Int Med 1991; 230: 101–108.CrossRefGoogle Scholar
  16. 17.
    Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 1993; 329: 304–309.PubMedCrossRefGoogle Scholar
  17. 18.
    The Diabetes Control an Complication Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–986.CrossRefGoogle Scholar
  18. 19.
    Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the diabetes control and complications trial. Kidney Int 1995; 42: 1703–1720.Google Scholar
  19. 20.
    Microalbuminuria Collaborative Study Group, United Kingdom. Intensive therapy and progression to clinical albuminuria in patients with insulin dependent diabetes mellitus and microalbuminuria. BMJ 1995; 311: 973–977.CrossRefGoogle Scholar
  20. 21.
    Malmberg K, Rydén L, Efendic S, Herlitz J, Nicol P, Waldenström A, Wedel H, Welin L on behalf of the Digami Study Group. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): Effects on mortality at 1 year. JACC 1995; 26: 57–65.PubMedCrossRefGoogle Scholar
  21. 22.
    Zuanetti G, Latini R, Maggioni AP, Santoro L, Franzosi MG, Tognoni G, on behalf of the GISSI-3 Investogators. Prognosis of diabetic patients after myocardial infarction: Effect of early treatment with ACE-inhibitors. JACC 1996; 319A.Google Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Bo Feldt-Rasmussen
    • 1
  1. 1.Medical Department PRigshospitaletCopenhagenDenmark

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