OCCURRENCE OF LATE SPECIFIC COMPLICATIONS IN TYPE-II (NON-INSULIN-DEPENDENT) DIABETES-MELLITUS

The objective of the present study was to determine the occurrence of late specific complications, i.e., nephropathy, retinopathy, and auton omic neuropathy, in type II (non-insulin-dependent) diabetic subjects with a recent onset and with a disease duration of at least 5 years. T he study design comprised of a population-based controlled cross-secti onal survey of middle-aged type II diabetic subjects in the City of Ta mpere, Southwest Finland. The mean (SD) albumin excretion rate per 24 h was found to have increased in recently diagnosed diabetic subjects, i.e., 54 (111) mg (p < 0.0001), and in long-term diabetic subjects, 1 34 (479) mg (p < 0.0001), compared to nondiabetic controls, 16 (19) mg . Microalbuminuria (30 mg/24 h less than or equal to albumin excretion rate less than or equal to 300 mg/24 h) was detected in 8% of nondiab etic subjects and in 29% of recently diagnosed subjects and 27% of lon g-term diabetic subjects. The prevalence of clinical nephropathy (albu min excretion rate > 300 mg/24 h) was 7% in long-term and 4% in recent ly diagnosed diabetic subjects and zero in nondiabetic subjects. The d ifferences between diabetic and nondiabetic subjects tested for microa lbuminuria and clinical nephropathy were significant (p = 0.02-0.0001) exempting the difference between recently diagnosed female diabetic s ubjects and nondiabetic female subjects tested for clinical nephropath y. Seventy-five percent of biopsied diabetic subjects with an albumin excretion rate exceeding 100 mg/24 h were found to have diabetic glome rulosclerosis, while the rest had a normal finding. In long-term diabe tic subjects the prevalence of nonspecific, background and proliferati ve retinopathies were present in 40%, 31%, and 8%, respectively. The p revalences for recently diagnosed diabetic subjects were 17%, 6%, and 0%. Nendiabetic subjects displayed some nonspecific retinopathy, i.e., in 6%, and in one subject preretinal hemorrhage and lipid exudates we re found, i.e., background retinopathy. The differences for the retino pathies between all the study groups were significant (p = 0.03-0.0000 ) except between recent diabetic and nondiabetic subjects for prolifer ative retinopathy. The mean (SD) values for the age-corrected cardiova scular reflex tests (Valsalva, deep breathing, and orthostatic tests) were for recently diagnosed diabetic subjects 1.48 (0.31), 1.22 (0.15) , and 1.21 (0.14) and for long-term diabetic subjects 1.44 (0.27), 1.1 8 (0.10), and 1.20 (0.15). Nondiabetic subjects had higher values, i.e ., 1.58 (0.33), 1.22 (0.12), and 1.24 (0.14), respectively. The differ ences between the long-term diabetic and nondiabetic subjects were sig nificant (p = 0.01-0.0001). The difference for the Valsalva test betwe en recently diagnosed diabetic and nondiabetic subjects was also signi ficant (p = 0.0087). Using cut-off points appearing in the literature for the three tests, ''definite or possible'' autonomic neuropathy was diagnosed in 12% of long-term, in 8% of recently diagnosed diabetic a nd in 2% of nondiabetic control subjects. In conclusion, specific diab etic complications were present in a substantial number of cases among recently diagnosed type II diabetic subjects when sensitive tests wer e utilized. After one decade of diabetes the complications appeared to be even more frequent and severe.