Cigarette smoking increases risk of albuminuria among subjects with type I diabetes

Article Abstract:

Kidney failure is the leading cause of death among people with insulin-dependent (type I) diabetes, and borderline high blood pressure (hypertension) causes an increase in both kidney and eye (retinal) damage. Although a review found the results of previous studies of smoking to be equivocal, it may be that smokers have personality traits, such as rebelliousness, that put them at greater risk. This study separates the effect of smoking on the development of kidney and eye damage among 359 young diabetics. Cigarette smoking did cause significant development and progression of albuminuria, a condition of a protein, albumin, in the urine. This results from kidney disease, caused in this case by diabetes. Smokers were almost three times as likely to have this symptom than nonsmokers. On the other hand, there was no association between smoking and eye damage. No other studies have recorded sugar levels in the blood (serial glycohemoglobin, or HbA-1c), and in this study, these levels were consistently higher for smokers. This poor control may be the result of the adverse effect of cigarette smoking on hormones that help control insulin. Even after this effect was taken out, smoking still affected albuminuria. Although smoking does not cause eye damage, the hypothesis that it causes faster deterioration does fit the pattern of these data. Smoking is therefore an important risk factor for the development of kidney disease among type I diabetics, and therefore these patients should be strongly urged to quit smoking in order to reduce the incidence of complications and increase their lifespan. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Causes of, Smoking, Type 1 diabetes, Albuminuria

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High-normal blood pressure and early diabetic nephropathy

Article Abstract:

Hypertension, or high blood pressure, affects the development of diabetic nephropathy, or kidney disease, but the relation between high-normal blood pressure and the progression of diabetic nephropathy is not known. A high-normal blood pressure is defined as blood pressure that is more than the 90th percentile for a particular age, or that is greater than blood pressure of 90 percent of persons. Microalbuminuria, or the presence of the blood protein albumin in the urine, is a good indicator of early kidney disease, and occurs in young type I or insulin-dependent diabetics with normal blood pressures. The criteria for diagnosing hypertension were developed for normal adults not at high risk for developing kidney disease, and may not apply to diabetics with increased risk of nephropathy. If high-normal blood pressures are related to microalbuminuria, treatment of blood pressure increases may delay or prevent progression of kidney disease. The relation between high-normal blood pressure and diabetic nephropathy, as indicated by microalbuminuria, was assessed in 230 diabetic subjects. Microalbuminuria was almost three times more common in the diabetic patients with high-normal blood pressure, compared with patients whose blood pressures were less than the 90th percentile. Increased microalbumin excretion was also related to high-normal diastolic blood pressures, which is measured during the relaxation phase of the heart cycle. Either microalbuminuria or high-normal blood pressure can occur before the other. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Prevention, Risk factors, Blood pressure, Diabetic nephropathies, Serum albumin, Blood pressure measurement

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Glucose control and the renal and retinal complications of insulin-dependent diabetes

Article Abstract:

Insulin-dependent diabetes mellitus (IDDM), a chronic syndrome caused by insufficient secretion of insulin and resulting in impaired carbohydrate, protein and fat metabolism, may cause kidney (renal) damage and damage to the retina (diabetic retinopathy). Insulin, a protein hormone secreted by the pancreas, is essential to the metabolism of blood sugar (glucose) and for the maintenance of the proper blood sugar level. The relationship of glucose control, age and the length of time the patient had diabetes (duration) to kidney and retinal damage was evaluated. Patients with long-term poor glucose control were 3.6 times more likely than patients with good glucose control to have traces of blood protein in their urine (microalbuminuria), indicating kidney damage, since albumin is synthesized in the liver. In addition, these patients were 2.5 times more likely to develop retinopathies than patients with long-term good glucose control. Glucose control was the most important factor determining the extent of kidney damage. The duration of the disease was less of a factor in predicting kidney damage. The most significant factors influencing the extent of eye disease were duration of diabetes, followed by glucose control and the age of the patient.

Case studies, Control, Glucose, Glycosylated hemoglobin

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