KIDNEY-FUNCTION IN PHASIC INSULIN-DEPENDENT DIABETES-MELLITUS IN JAMAICA

In Jamaica, malnutrition related diabetes mellitus (MRDM) presents the clinical picture of phasic insulin dependence. This study was underta ken to investigate nephropathic changes associated with this group of patients. Fourteen phasic insulin dependent diabetes mellitus (PIDDM) patients were compared with 10 insulin dependent (IDDM) and 10 non-ins ulin dependent (NIDDM) diabetes mellitus patients, and 10 normal contr ols. Each group was matched for age, sex, body mass index (BMI) and in the case of the diabetic patient controls, duration of diabetes. Urin ary microalbumin concentration was significantly (p < 0.05) higher in the PIDDM group (mean +/- SD: 153 +/- 48.3 mg/dl) than in the groups o f NIDDM (35.7 +/- 9.6 mg/dl) or IDDM (38.6 +/- 15.8 mg/dl) patients. S erum urea and creatinine concentrations (mean +/- SE 7.6 +/- 1.0 mmol/ l and 130.0 +/- 20.3 mu mol/l, respectively) were higher in the PIDDM patients than in the NIDDM and IDDM groups. Confounding factors such a s hypertension and urinary tract infections, were excluded as causes f or these differences. We conclude that PIDDM patients have more severe renal dysfunction than NIDDM patients and, since glycosylated haemogl obin concentrations are comparable in these groups, we attribute this to a renal insult due to malnutrition predating the onset of the PIDDM .