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- Torffvit, Ole, et al.
(författare)
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Day and night variation in ambulatory blood pressure in type 1 diabetes mellitus with nephropathy and autonomic neuropathy
- 1993
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Ingår i: Journal of Internal Medicine. - 1365-2796. ; 233:2, s. 131-137
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to study ambulatory blood pressure and heart rate variability between day and night in patients with type 1 (insulin-dependent) diabetes mellitus with different degrees of diabetic nephropathy, and to evaluate the influence of autonomic neuropathy and type of antihypertensive treatment. Twenty type 1 diabetic patients with diabetic nephropathy and antihypertensive treatment were studied with 24-h ambulatory blood pressure monitoring using an oscillometric method. They were compared with eight insulin-treated diabetic patients with short duration of diabetes (1-5 years) and with 10 apparently healthy subjects. The degree of autonomic neuropathy was evaluated by measuring the RR-interval during deep breathing and uprising. The 24-h blood pressure was generally higher in patients with diabetic nephropathy compared to those other two groups. These patients also had a lower ratio between day and night in diastolic blood pressure compared to the control subjects (1.15 +/- 0.12 vs. 1.25 +/- 0.76, P < 0.05) and heart rate compared to the diabetic patients without nephropathy, as well as the control subjects (1.15 +/- 0.08 vs. 1.26 +/- 0.09 vs. 1.27 +/- 0.08, P < 0.01, respectively). All patients with diabetic nephropathy had clinical signs of autonomic neuropathy as judged by RR-interval measurements during deep breathing and uprising.
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| 2. |
- Torffvit, Ole, et al.
(författare)
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Tubular secretion of Tamm-Horsfall protein is decreased in type 1 (insulin-dependent) diabetic patients with diabetic nephropathy
- 1993
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Ingår i: Nephron. - 0028-2766. ; 65:2, s. 227-231
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Tidskriftsartikel (refereegranskat)abstract
- Signs of glomerular, proximal and distal tubular dysfunction as well as metabolic control were studied in type 1 diabetes mellitus. To that end, the urinary excretion rates of albumin, sodium, phosphate and Tamm-Horsfall protein as well as HbA1c levels were measured in 20 patients with different degrees of diabetic nephropathy (positive Albustix for several years). Eight diabetic patients with short duration of diabetes and without any diabetic complications and 10 apparently healthy subjects were studied for comparison. The HbA1c levels in the three groups were 8.6 +/- 1.2, 5.9 +/- 2.2 and 4.1 +/- 0.4%, respectively (mean +/- SD). Duration of diabetes in the two diabetic groups were 27 +/- 7 and 3 +/- 1 years, respectively. The urinary protein levels were measured by enzyme-linked immunoassays. The fractional clearance of sodium (1.9 +/- 1.9%; p < 0.001) and phosphate (27 +/- 11%; p < 0.01) were increased in patients with diabetic nephropathy compared to diabetic patients without nephropathy (0.6 +/- 0.2 and 16 +/- 4%) and healthy control subjects (0.6 +/- 0.1 and 16 +/- 4%, respectively). Tamm-Horsfall protein excretion rate was decreased in both diabetic groups (15.0x/3.1 and 37.9x/1.9 micrograms/min, geometric mean x/tolerance factor, p < 0.001 and p < 0.05, respectively) compared to the healthy subjects (63.8x/1.3 micrograms/min). Furthermore, patients with diabetic nephropathy had a lower excretion rate of Tamm-Horsfall protein (15.0x/3.1 micrograms/min) compared to patients without signs of nephropathy (37.9x/1.9 micrograms/min, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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| 3. |
- Torffvit, Ole, et al.
(författare)
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The predictive value of albuminuria for cardiovascular and renal disease. A 5-year follow-up study of 476 patients with type I diabetes mellitus
- 1993
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Ingår i: Journal of Diabetes and its Complications. - 1873-460X. ; 7:1, s. 49-56
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Tidskriftsartikel (refereegranskat)abstract
- A 5-year follow-up study of 476 type I adult diabetic patients previously studied cross sectionally revealed that, during the observation period, 19 patients died and 30 developed cardiovascular or renal disease, such as myocardial infarction (n = 8), cerebrovascular disease (n = 3), amputation (n = 6), and renal insufficiency (n = 13). The patients were registered by one and the most-severe event only. The yearly death rate was 8.0 per 1000, compared with the expected death rate of 2.0 for people with corresponding age and sex in the general population. In patients with renal insufficiency, one also had myocardial infarction, and one had had an amputation. The ages of patients who died, with myocardial infarction, cerebrovascular disease, amputation, or renal insufficiency, were 44.2 +/- 12.7, 41.3 +/- 6.6, 43.7 +/- 13.2, 45.3 +/- 15.7, and 40.8 +/- 9.8 years, respectively. Urinary albumin concentration in a single early morning urine sample was found to be a strong prognostic marker for the development of cardiovascular disease or death. In contrast, age, gender, age at onset and duration of diabetes, levels of blood pressure, serum creatinine, and HbA1c, or presence of hypertension, as well as changes in blood pressure and hBa1c, during the observation period did not influence the survival or incidence of cardiovascular disease. However, blood pressure and HbA1c were associated with increased urinary albumin concentrations during the follow-up period.
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