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TIGHT CONTROL DELAYS DIABETIC RENAL CHANGES.

Transplanted kidneys in patients with type I diabetes develop diabetic abnormalities after only 2 to 4 years. This unfortunate phenomenon makes such patients valuable for studying interventions aimed at preventing diabetic nephropathy. This randomized, controlled trial compared maximized with standard glucose control in 96 type I diabetics who had received renal transplants.

The maximized-control group received subcutaneous insulin several times a day or continuously. The standard-care group received insulin once or twice daily. When patients underwent renal biopsy five years after transplantation, those who had received the intensive therapy showed less severe diabetic changes, including less than half the increase in the volume fraction of mesangial matrix per glomerulus. Intensively treated patients had more severe hypoglycemic episodes (1.7 per patient per year versus less than 0.1 in the standard-care group).

Comment: These findings strengthen the case for tight control of diabetes. In addition to the renal benefits, it is impressive that so many patients were able to sustain maximized glucose control for such a long period. Nevertheless, hypoglycemia remains a formidable obstacle to tight glucose control.

— TH Lee

Published in Journal Watch General Medicine September 13, 1994

Citation(s):

Barbosa J et al. Effect of glycemic control on early diabetic renal lesions: a 5-year randomized controlled clinical trial of insulin-dependent diabetic kidney transplant recipients. JAMA 1994 Aug 24 272 600-606.

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