L'effetto a lungo termine dell'€™infusione subcutanea continua di insulina mediante microinfusore comparato alla terapia insulinica multiiniettiva sulla funzione renale, sul tasso di escrezione urinaria di albumina e sulla pressione arteriosa in pazienti con diabete di tipo 1 con microalbuminuria persistente.
Year: 2014
Type: article
Abstract: The long-term effect of continuous subcutaneous insulin infusion (CSII) compared to multiple daily insulin injection (MDI) on renal function, albumin excretion rate and blood pressure in type 1 diabetic patients with persistent microalbuminuria. \nSummary \nAim. To evaluate the long-term effect (3 years) of continuous subcutaneous insulin infusion (CSII) compared to multiple daily insulin injection (MDI) on renal function, albumin excretion rate(AER), blood pressure and blood glucose variability in type 1 diabetic patients with persistent microalbuminuria.in optimal antihypertensive treatment (ie, with a maximum tolerated dose of ACE-inhibitors). \nMethods. In a multicentre prospective study were enrolled 62 type 1 diabetic patients with persistent microalbuminuria: 26 patients treated with CSII and 24 treated with MDI (with glargine as basal insulin), matched for age (CSII 40.3±9.3 yrs., MDI 42.2±11.1 yrs.), diabetes duration (CSII 27±8.2 yrs, MDI 24.3±10.3 yrs.), BMI (CSII 24.4±3.2%, MDI 24.7±4.2%). All patients were treated with the maximal tolerated dose of ACE-inhibitor therapy.Every 6 months, were performed 24-hour blood pressure profiles and interstitial continuous glucose monitoring and were also determined kidney function as glomerural filtration rate (GFR), albumin excretion rate excretion rate of 8-iso-PGF2alfa (as oxidative stress marker). \nResults. Albumin excretion rate decreased slightly in MDI group from a median value of 62 μg/min (31-100 IQR) to 59 (33-155 IQR) after three years of follow-up. Albumin excretion rate decreased significantly (p<0.05) from a median value of 72 μg/min (37-154 IQR) to 24 (11-57 IQR) in CSII group. In particular only 3 patients in MDI group regressed to normoalbuminuria at the end of follow-up, whereas 14 patients in CSII group regressed to normoalbuminuria (p<0.001). GFR was similar in both groups at entry into the study. During the study a decline of GFR was greater in patients treated with MDI (-7.9±9.9 ml/min/yr) than those in CSII (-3.08±3.3 ml/min/yr; p < 0.05). A1c levels were similar in MDI and CSII groups at entry into the study (8.4±1.5% vs 8.2 ± 1.0% respectively) and remained unchanged throughout the study (A1c 7.8±1.2 % in MDI group vs 8.0±1.1% in CSII group). Also glycemic variability index remained unchanged throughout the study. Insulin dose, in particular, total rapid insulin dosage was significantly higher in MDI group than boluses in CSII group both at entry (0.36±0.4 vs 0.2±0.07 U//kg/day) and at the end of study (0.28±17 vs 0.19±0.08 U/kg/day)(p<0.01). 24-hour blood pressure was well controlled in both groups and stable throughout the study. At the end of the study the systolic blood pressure (SBP) was CSII group 127±13 mm/Hg and in MDI group 127±10 mmHg; the diastolic blood pressure (DBP) was in CSII group 75±7 in MDI group 74±4 mmHg mmHg. \nConclusion. Insulin treatment with continuous subcutaneous insulin infusion was associated to a reduction in the progression of renal damage despite a similar glycemic control. The higher insulin requirement of MDI group suggests a state of insulin resistance, a possible factor in the progression of renal disease. Glycemic variability (VG) does not seem to play an important role in the results obtained. \n
Author: Zarra, Emanuela
Institution: University of Padua
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2307861079