THE RELATIONSHIP BETWEEN EARLY DIABETIC NEPHROPATHY AND CONTROL OF PLASMA-GLUCOSE IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS - THE EFFECT OF GLYCEMIC CONTROL ON THE DEVELOPMENT AND PROGRESSION OF DIABETIC NEPHROPATHY IN AN 8-YEAR FOLLOW-UP-STUDY

To clarify the relationship between early diabetic nephropathy and the glycemic control in non-insulin-dependent diabetes mellitus (NIDDM) w ithout hypertension, excretion of urinary albumin was studied retrospe ctively for 8 years. The patients with early diabetic nephropathy were divided into two groups according to the initial urinary albumin inde x (UAI: mg/g.creatinine), namely, a normoalbuminuric (less than 15 mg/ g.creatinine) and a microalbuminuric group (15 less-than-or-equal-to U AI < 200 mg/g.creatinine). Comparisons of changes in UAI were made bet ween good (HbA1 < 9.0% and fasting plasma glucose (FPG) < 140 mg/100 m L throughout the observation period) and poor glycemic control groups after 4 and 8 years. In the patients with normoalbuminuria at the init ial determination, five of 11 patients (45.5%) with good glycemic cont rol and 14 of 22 patients (63.6%) with poor glycemic control became mi croalbuminuric after 8 years, respectively (p < 0.05). In the microalb uminuric patients, five of ten patients (50%) with poor glycemic contr ol became macroalbu minuric (UAI greater-than-or-equal-to 200 mg/g. cr eatinine), although only one case worsened of five patients with good glycemic control (p < 0.05). In conclusion, the development or progres sion of early diabetic nephropathy in NIDDM was significantly inhibite d by good glycemic control (FPG < 140 mg/100 mL and HbA1 < 9.0%), inde pendent of hypertension, and probably irrespective of the mode of ther apeutic intervention.