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Regression of microalbuminuria in type 1 diabetic patients: results of a sequential intervention with improved metabolic control and ACE inhibitors.
Acta Diabetol 2005; 42(2):87-94AD

Abstract

The objective was to evaluate the effect of improved metabolic control and ACE inhibition used sequentially in the treatment of type 1 diabetic patients with microalbuminuria. We studied 44 consecutive type 1 diabetic patients with microalbuminuria not previously treated with ACE inhibitors. Improved metabolic control (optimisation period) was attempted for 6-12 months and patients with persistent microalbuminuria were subsequently treated with ACE inhibitors. Stepwise logistic regression analysis included the variables age, age at diabetes onset, duration of diabetes, HbA1c, initial albumin excretion rate (AER) and mean blood pressure as predictors of final AER. Thirty per cent of patients regressed to normoalbuminuria after the optimisation period, and 58% of them maintained normal AER 4.5+/-1.3 years later (3-7 years). Patients achieving normoalbuminuria had lower baseline AER (53+/-22 vs. 94+/-63 mg/24 h, p=0.012). The initial AER level was the only factor associated with final AER (r=0.58, p=0.021). Thirty patients with persistent microalbuminuria were treated with ACE inhibitors for two years, 35.5% of whom regressed to normal AER. Patients achieving normoalbuminuria after ACE inhibitor treatment had lower baseline AER (55+/-24 vs. 132+/-75 mg/24 h, p=0.03). The initial AER was the sole predictor of final AER (r=0.51, p<0.013). Overall, the sequential use of improved metabolic control and ACE inhibitor therapy resulted in long-term normalisation of AER in 47.4% of patients. The sequential implementation of improved metabolic control and ACE inhibitor therapy had a long-term beneficial effect in type 1 diabetic patients with microalbuminuria. We propose that type 1 diabetic patients with microalbuminuria could benefit from a period of metabolic improvement before the initiation of ACE inhibitor therapy.

Authors+Show Affiliations

Endocrine Unit (13-2), Hospital Universitari Bellvitge, Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, Spain.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15944842

Citation

Vilarrasa, N, et al. "Regression of Microalbuminuria in Type 1 Diabetic Patients: Results of a Sequential Intervention With Improved Metabolic Control and ACE Inhibitors." Acta Diabetologica, vol. 42, no. 2, 2005, pp. 87-94.
Vilarrasa N, Soler J, Montanya E. Regression of microalbuminuria in type 1 diabetic patients: results of a sequential intervention with improved metabolic control and ACE inhibitors. Acta Diabetol. 2005;42(2):87-94.
Vilarrasa, N., Soler, J., & Montanya, E. (2005). Regression of microalbuminuria in type 1 diabetic patients: results of a sequential intervention with improved metabolic control and ACE inhibitors. Acta Diabetologica, 42(2), pp. 87-94.
Vilarrasa N, Soler J, Montanya E. Regression of Microalbuminuria in Type 1 Diabetic Patients: Results of a Sequential Intervention With Improved Metabolic Control and ACE Inhibitors. Acta Diabetol. 2005;42(2):87-94. PubMed PMID: 15944842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regression of microalbuminuria in type 1 diabetic patients: results of a sequential intervention with improved metabolic control and ACE inhibitors. AU - Vilarrasa,N, AU - Soler,J, AU - Montanya,E, PY - 2004/01/16/received PY - 2005/03/30/accepted PY - 2005/6/10/pubmed PY - 2005/10/5/medline PY - 2005/6/10/entrez SP - 87 EP - 94 JF - Acta diabetologica JO - Acta Diabetol VL - 42 IS - 2 N2 - The objective was to evaluate the effect of improved metabolic control and ACE inhibition used sequentially in the treatment of type 1 diabetic patients with microalbuminuria. We studied 44 consecutive type 1 diabetic patients with microalbuminuria not previously treated with ACE inhibitors. Improved metabolic control (optimisation period) was attempted for 6-12 months and patients with persistent microalbuminuria were subsequently treated with ACE inhibitors. Stepwise logistic regression analysis included the variables age, age at diabetes onset, duration of diabetes, HbA1c, initial albumin excretion rate (AER) and mean blood pressure as predictors of final AER. Thirty per cent of patients regressed to normoalbuminuria after the optimisation period, and 58% of them maintained normal AER 4.5+/-1.3 years later (3-7 years). Patients achieving normoalbuminuria had lower baseline AER (53+/-22 vs. 94+/-63 mg/24 h, p=0.012). The initial AER level was the only factor associated with final AER (r=0.58, p=0.021). Thirty patients with persistent microalbuminuria were treated with ACE inhibitors for two years, 35.5% of whom regressed to normal AER. Patients achieving normoalbuminuria after ACE inhibitor treatment had lower baseline AER (55+/-24 vs. 132+/-75 mg/24 h, p=0.03). The initial AER was the sole predictor of final AER (r=0.51, p<0.013). Overall, the sequential use of improved metabolic control and ACE inhibitor therapy resulted in long-term normalisation of AER in 47.4% of patients. The sequential implementation of improved metabolic control and ACE inhibitor therapy had a long-term beneficial effect in type 1 diabetic patients with microalbuminuria. We propose that type 1 diabetic patients with microalbuminuria could benefit from a period of metabolic improvement before the initiation of ACE inhibitor therapy. SN - 0940-5429 UR - https://www.unboundmedicine.com/medline/citation/15944842/Regression_of_microalbuminuria_in_type_1_diabetic_patients:_results_of_a_sequential_intervention_with_improved_metabolic_control_and_ACE_inhibitors_ L2 - https://dx.doi.org/10.1007/s00592-005-0184-0 DB - PRIME DP - Unbound Medicine ER -