Residual insulin production, glycaemic control and prevalence of microvascular lesions and polyneuropathy in long-term Type 1 (insulin-dependent) diabetes mellitus (original) (raw)

Summary

The aim of the present study was to evaluate the role of residual insulin production in long-term Type 1 (insulin-dependent) diabetes mellitus. Ninety-seven patients with a disease duration of 9–16 years and onset before the age of 30 years were studied. C-peptide excretion in 24-h urine samples was measured as an indicator of residual insulin production. Thirty-five patients (36%) excreted C-peptide (>-0.2 nmol); as many as possible of them were carefully matched with a non-excretor patient with regard to age at onset of diabetes and disease duration. Twenty-nine pairs were obtained, and 22 of them agreed to participate in further investigations of glycaemic control and microangiopathic lesions. The patients who excreted C-peptide had significantly lower HbA1c than the non-excretor group, 6.9±0.3% vs 7.9±0.3%, (p<0.025). Moderate-to-advanced background retinopathy was found in 2 patients in the excretor group and in 7 patients in the nonexcretor group. Microalbuminuria [ratio of albumin: creatinine (mg/l:mmol/l) >-5] was found in 1 and in 5 patients, respectively, while proteinuria [ratio of protein: creatinine (mg/l: mmol/l× 10) >-136] was found in 0 and in 4 patients, respectively. Microalbuminuria and/or proteinuria was found in 7 of the non-excretor group as compared to 1 in the excretor group (_p_=0.046). When all the variables were taken into account, microalbuminuria and/or proteinuria and/or moderate-to-advanced background retinopathy was found in 3 of the excretor group compared to 11 of the non-excretor group (_p_=0.022). Reduced sensory and motor nerve conduction velocities were common findings and occurred with the same frequency in the two groups. The data suggest that residual insulin production in long-term Type 1 diabetes is associated with a more satisfactory glycaemic control and a lower prevalence of early microangiopathic eye and kidney lesions.

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References

  1. Pirart J (1978) Diabetes mellitus and its degenerative complications, a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care 1: 168–188 and 252–263
    Google Scholar
  2. Clements RS Jr (1979) Diabetic neuropathy — new concept of its etiology. Diabetes 28: 604–611
    Google Scholar
  3. Sjöberg S, Gunnarsson R, Östman J (1983) Residual C-peptide production in Type 1 diabetes mellitus. A comparison of different methods of assessment and influence on glucose control. Acta Med Scand 214: 231–237
    Google Scholar
  4. Rogers S, Silink M (1985) Residual insulin secretion in insulin-dependent diabetes mellitus. Arch Dis Child 60: 200–203
    Google Scholar
  5. Faber OK, Binder C (1977) B-cell function and blood glucose control in insulin-dependent diabetics within the first month of insulin treatment. Diabetologia 13: 263–268
    Google Scholar
  6. Bodansky HJ, Medbak S, Drury PL, Cudworth AG (1981) Plasma C-peptide in long-standing type 1 diabetics with and without microvascular disease. Diabete Metab 7: 265–269
    Google Scholar
  7. Eff C, Faber O, Deckert T (1978) Persistent insulin secretion, assessed by plasma C-peptide estimation in long-term juvenile diabetics with a low insulin requirement. Diabetologia 15: 169–172
    Google Scholar
  8. Mosier M (1984) Circulating C-peptide and diabetic retinopathy. Diabetes Research 1: 151–154
    Google Scholar
  9. Heding LG (1975) Radioimmunological determination of human C-peptide in serum. Diabetologia 11: 541–548
    Google Scholar
  10. Trivelli LA, Rawney HM, Lai H-T (1971) Hemoglobin components in patients with diabetes mellitus. N Engl J Med 284: 353–357
    Google Scholar
  11. Faber OK, Binder C (1977) C-peptide response to glucagon. Diabetes 26: 605–619
    Google Scholar
  12. Shaw AB, Risdon P, Lewis-Jackson JD (1983) Protein creatinine index and albustix in assessment of proteinuria. Br Med J 187: 929–932
    Google Scholar
  13. Blom M, Hjörne N (1975) Immunochemical determination of serum albumin with a centrifugal analyser. Clin Chem 21: 195–198
    Google Scholar
  14. Gatling W, Knight C, Hill RD (1985) Screening for early diabetic nephropathy: which sample to detect microalbuminuria. Diabetic Med 2: 451–455
    Google Scholar
  15. Osserman EF (1975) Lysozyme. N Engl J Med 292: 424
    Google Scholar
  16. Granerus G, Aurell M (1981) Reference values for 51Cr-EDTA clearance as a measure of glomerular filtration rate. Scand J Clin Lab Invest 41: 611–616
    Google Scholar
  17. Hillbom M, Wennberg A (1984) Prognosis of alcoholic peripheral neuropathy. J Neurol Neurosurg Psychiatry 47: 699–703
    Google Scholar
  18. Persson A, Solders G (1983) R-R variations, a test of autonomic dysfunction. Acta Neurol Scand 67: 285–293
    Google Scholar
  19. Meistas MT, Rendell M, Margolis S, Kowarski AA (1982) Estimation of the secretion rate of insulin from the urinary excretion rate of C-peptide. Diabetes 31: 449–453
    Google Scholar
  20. Madsbad S, Faber OK, Binder C, McNair P, Christiansen C, Transbol J (1978) Prevalence of residual beta-cell function in insulin-dependent diabetics in relation to age at onset and duration of diabetes. Diabetes 27 [Suppl 1]: 262–264
    Google Scholar
  21. Ludvigsson J, Heding LG (1976) C-peptide in children with juvenile diabetes. Diabetologia 12: 627–630
    Google Scholar
  22. Hoogwerf BJ, Rich SS, Barbosa J (1985) Meal-stimulated C-peptide and insulin antibodies in type 1 diabetic subjects and their non-diabetic siblings characterized by HLA-DR antigens. Diabetes 34: 440–445
    Google Scholar
  23. Marner B, Agner T, Binder C, Lernmark Å, Nerup J, Mandrup-Poulsen T, Walldorff S (1985) Increased reduction in fasting C- peptide is associated with islet cell antibodies in Type 1 (insulin-dependent) diabetic patients. Diabetologia 28: 875–880
    Google Scholar
  24. Telmar S, Sandahl Christiansen J, Andersen AR, Nerup J, Deckert T (1984) Smoking habits and prevalence of clinical diabetic microangiopathy insulin-dependent diabetics. Acta Med Scand 215: 63–68
    Google Scholar
  25. Viberti GC, Keen H, Mackintosh D (1981) Beta2-microglobulinaemia: a sensitive index of diminishing renal function in diabetics. Br Med J 282: 95–98
    Google Scholar
  26. Bernier MG, Conrad ME (1969) Catabolism of human beta2-microglobulin by the rat kidney. Am J Physiol 217: 1359–1362
    Google Scholar
  27. Young RJ, Macintyre CCA, Martyn CN, Prescott RJ, Smith AF, Viberti G, Clarke BF (1986) Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications). Diabetologia 29: 156–161
    Google Scholar
  28. Viberti GC, Jarrett RJ, Mawood U, Hill RD, Arguropolos A, Keen H (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1: 1430–1432
    Google Scholar

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Authors and Affiliations

  1. Department of Medicine, Huddinge Hospital, Karolinska Institute, Huddinge, Sweden
    S. Sjöberg, R. Gunnarsson & J. Östman
  2. Department of Ophthalmology, Huddinge Hospital, Karolinska Institute, Huddinge, Sweden
    M. Gjötterberg
  3. Department of Clinical Chemistry, Huddinge Hospital, Karolinska Institute, Huddinge, Sweden
    A. K. Lefvert
  4. Department of Clinical Neurophysiology, Huddinge Hospital, Karolinska Institute, Huddinge, Sweden
    A. Persson

Authors

  1. S. Sjöberg
  2. M. Gjötterberg
  3. A. K. Lefvert
  4. J. Östman

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Sjöberg, S., Gunnarsson, R., Gjötterberg, M. et al. Residual insulin production, glycaemic control and prevalence of microvascular lesions and polyneuropathy in long-term Type 1 (insulin-dependent) diabetes mellitus.Diabetologia 30, 208–213 (1987). https://doi.org/10.1007/BF00270417

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