EFFECT OF INTENSIVE TREATMENT ON DIABETIC NEPHROPATHY IN PATIENTS WITH TYPE-I DIABETES

We evaluated the long-term effect of an intensive treatment of diabeti c nephropathy (anti-hypertensive drugs, low protein diet, multiple ins ulin injections to achieve a good metabolic control) on glomerular fil tration rate (GFR) and albumin excretion rate (AER). Fourteen type I d iabetic patients (mean age 45 +/- 9.5 years, mean duration of diabetes 23.5 +/- 7.3 years, 8 males/6 females) with glomerular filtration rat e <70 ml/min(-1)/1.73 m(2) and albumin excretion rate >30 mu g/min wer e treated intensively for 36 months. This intensive treatment consiste d of multiple insulin injections, antihypertensive therapy with ACE in hibitors and a low-protein diet (0.8 g/kg body wt/day.) Renal function was evaluated as GFR and AER. HbA,c mean value decreased significantl y from 8.7 +/- 0.8% to 6.5 +/- 0.5% (P < 0.0002). GFR rose from 58 +/- 12 ml/min(-1)/1.73 m(2) to 84 +/- 11 ml/min(-1)/1.73 m(2) (P < 0.0008 ). AER decreased from 208 mu g/min (range: 73 to 500) to 63.8 mu g/min (range 15 to 180; P < 0.05). Systolic and diastolic blood pressure de creased respectively from 144 +/- 26 mm Hg to 120 +/- 15 mm Hg and fro m 89 +/- 9 mm Hg to 75 +/- 8 mm Hg (P < 0.01). We obtained a rise of G FR and a reduction of proteinuria after three years of this treatment. We suggest that this intensive treatment in all patients with early s tage diabetic nephropathy may be effective in slowing the progression to renal failure.