Pathological Proteinuria in Patients with Insulin-Dependent Diabetes Mellitus: Relation to Intensive Insulin Therapy¹

Summary

A matched case-control study was performed to assess the prevalence of pathological proteinuria (>50mg/l) 18 — 34 years after onset of insulin-dependent diabetes mellitus (IDDM), in relation to intensive insulin therapy. Three groups of patients were studied ≥18 years after onset of IDDM. In patients of group A and group B, intervention took place ≥ 8 years after onset of IDDM: group A changed from traditional insulin therapy to continuous subcutaneous insulin infusion (CSII), and patients of group B changed from traditional insulin treatment (< 3 injections/day) to multiple daily insulin injection therapy. Patients of group C continued traditional insulin therapy without intervention. The prevalence of pathological proteinuria was 3/21, 5/21, and 15/21 in group A, B, and C, respectively; 22.0 (95% confidence interval: 19.5 to 24.5) years, 22.1 (19.9 to 24.3) years, and 22.6 (20.2 to 25.0) years after onset of IDDM in group A, B, and C. The prevalence of pathological proteinuria differed significantly between group A and B vs. group C (x₂ = 16.2, p < 0.001; odds ratio 15 (3.2 to 70.3)). Glycosylated haemoglobin was 7.5 (6.9 to 8.1)% in group A, 7.6 (6.3 to 8.3) % in group B, and 8.9 (8.2 to 9.6) % in group C. In group A and B, 4/21 patients had hypertension, compared to 11/21 patients in group C. In group B, 1/21 patients had serum-creatinine > 130 µmol/1.

Conclusion: Intensive insulin therapy either by CSII or by multiple injections initiated ≥ 8 years after onset of IDDM was associated with reduced prevalence of pathological proteinuria 10 years later, as compared to ongoing traditional insulin therapy during ≥ 18 years after onset of IDDM.

Key words

Insulin-dependent diabetes mellitus - Complications-Insulin therapy - Insulin pumps