METABOLIC-REGULATION AND MICROANGIOPATHY IN A COHORT OF JAPANESE IDDM-PATIENTS

In Caucasian patients with insulin-dependent diabetes mellitus (IDDM) proliferative diabetic retinopathy (PDR) and persistent proteinuria (P P) are associated, and major risk factors for development of microangi opathy have been identified. The aim of the present study was to evalu ate whether these risk factors are also relevant and whether an associ ation exists between the microangiopathic complications in Japanese ID DM-patients. A clinic-based cohort of 324 Japanese IDDM-patients was f ollowed (a mean follow-up of 7 years). Annual examination for developm ent of PDR and PP was performed. Fifty-eight patients developed PDR an d 24 developed PP. Development of PDR was associated to high HbA(1c)-l evels, i.e., the 4th quartile (RR 7.9, P < 0.0001), background retinop athy at admission (RR 9.9, P < 0.0001), high age at diabetes onset (RR 2.9, P < 0.0001) and female gender(RR 1.7, P < 0.05). Development of PP was associated to high HbA,,-levels (RR 2.8, P < 0.001) and backgro und retinopathy at admission (RR 7.9, P < 0.0001). The risk of develop ing PP was 9 times higher in patients developing PDR than in patients not developing PDR (P < 0.0001). The effect of metabolic control in ou r cohort was similar to that found in the DCCT and SDIS studies. In co nclusion, development of PP is closely associated with PDR, also in Ja panese IDDM-patients. The effect of metabolic control is the same as i n Caucasian patients. Development of malignant angiopathy in IDDM-pati ents is not confined to Caucasian IDDM-patients, and the incidence rat es are comparable to those found in Caucasian IDDM.