No abstract available.
Diabetes Mellitus, Type 2/*blood ; Diabetic Nephropathies/*blood ; Diabetic Retinopathy/*blood ; Hemoglobins/*metabolism ; Humans ; Male

PURPOSE:To compare macular thickness and visual acuity before and after panretinal photocoagulation in patients with severe diabetic retinopathy without diabetic macular edema. METHODS: Macular thickness and visual acuity (LogMAR) of 40 eyes were compared before and after panretinal photocoagulation, for severe diabetic retinopathy. Macular thickness was measured by optical coherence tomography(OCT). In addition, changes in macular thickness and visual acuity were compared with the patient's level of HbA1c, blood pressure, and diabetic nephropathy. RESULTS: Mean visual acuity before and 1.47+/-0.80 months after panretinal photocoagulation were 0.28+/-0.23 and 0.33+/-0.27, respectively, which was not a significant decrease (p=0.131). However mean central macular thickness (216.98+/-34.09 microm to 255.22+/-73.40 microm), and mean peripheral macular thickness (269.26+/-34.59 microm to 291.96+/-46.49 microm) did increase significantly after panretinal photocoagulation (p=0.001). The decrease of mean visual acuity and increase of mean macular thickness were greater in patients with high blood glucose, high blood pressure and diabetic nephropathy. CONCLUSIONS: In eyes with severe diabetic retinopathy treated with panretinal photocoagulation, mean visual acuity did not decrease significantly, but mean central and peripheral macular thickness significantly increased after treatment. We posit that visual prognosis after panretinal photocoagulation in eyes with severe diabetic retinopathy without macular edema is influenced by the control of blood glucose and blood pressure and the presence of diabetic nephropathy.
Blood Glucose ; Blood Pressure ; Diabetic Nephropathies ; Diabetic Retinopathy ; Eye ; Humans ; Hypertension ; Light Coagulation ; Macular Edema ; Prognosis ; Visual Acuity

In order to assess the difference of autonomic dysfunction according to the absence or presence of nephropathy in patients with NIDDM, tests for cardiovascular autonomic function were performed in 23 NIDDM patients without nephropathy(M : F 14 : 9, mean age 50+/- 8) and in 21 patients with nephropathy (M : F 13 : 8, mean age 57+/-12). Tests for cardiovascular autonomic function included the R-R interval changes in response to respiration, Valsalva maneuver, and lying-standing, the blood pressure changes in response to lying-standing and sustained handgrip exercise. The prevalence of autonomic dysfunction was different between the patients without and with nephropathy(69.6% vs 85.7%). For patients without symptoms suggesting autonomic neuropathy, the significant differences were found in the change of R-R interval in response to respiration(22.16+/-21.30 vs 11.73+/-10.83; p=0.0390), in the change of lying-standing blood pressure(10.63+/-9.70 vs 22.00+/-13.67; p= 0.0044) and in the change of blood pressure during handgrip exercise(16.89+/-10.28 vs 8.40+/-7.24; p=0.0065). These results suggested that autonomic neuropathy may occur more frequently in patients with diabetic nephropathy than diabetes mellitus without neuropathy.
Blood Pressure ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Neuropathies ; Humans ; Prevalence ; Respiration ; Valsalva Maneuver

Diabetic nephropathy (DN) in mice induced by intraperitoneal injections of streptozotocin (STZ) three times at divided dosages; the first dosage of 50 mg/kg STZ was given to mice after 12-h fasting, followed by the second 50mg/kg STZ at 24-h after the first injection, and the third dosage of 100 mg/kg was given at 72-h after the first injection. The plasma glucose and creatinine levels gradually increased after the STZ treatment, indicating the onset of DB. Histopathological examination of the kidneys of mice treated with STZ revealed focal areas of mesangial proliferation with increased periodic acid-Schiff-positive materials. At 4 and 6 weeks diabetic groups after STZ treatment showed severely degenerated nuclei of the mesangial and endothelial cells. These results indicate that apoptic histopathological changes occurs in the kidney of the STZ-induced diabetic mellitus.
Animals ; Apoptosis* ; Blood Glucose ; Creatinine ; Diabetic Nephropathies* ; Endothelial Cells* ; Fasting ; Injections, Intraperitoneal ; Kidney ; Mice* ; Streptozocin

There are a few changes in the management of diabetic nephropathy (DN) in 2015 Korean Diabetes Association (KDA) Clinical Practice Guideline. Among them, restricting protein intake in patients with DN has been in controversy. Several guidelines in other countries recommend not to reduce the daily protein intake less than 0.8 g/kg/day in patients with DN, which is in agreement with the KDA guideline. Although the current KDA recommendation does not comment about high protein intake, several guidelines warn a high protein intake (> 1.3 g/kg/day) since it aggravates the progression of DN. The other issue is a target blood pressure (BP) in DN. It has been recommended that BP should be maintained at a lower level in patients with DN than in diabetic patients without nephropathy. Recently, failure to demonstrate the beneficial effects of lowering BP in reducing mortality or cardiovascular disease lead to increase the optimal BP target in diabetes from 130/80 to 140/90 mm Hg. Therefore, BP target should be individualized based on their comorbidities and life expectancy in DN patients. In this section, we recommend the optimization of BP control to reduce the risk or slow the progression of DN, rather than specify target BP levels.
Blood Pressure ; Cardiovascular Diseases ; Comorbidity ; Diabetic Nephropathies* ; Humans ; Life Expectancy ; Mortality

Diabetic nephropathy is a common complication of diabetes mellitus and is the leading cause of chronic kidney disease. Glycemic and blood pressure control constitute the main strategies of diabetic nephropathy prevention and treatment. However, despite current therapies, nephropathy progresses to renal failure and end-stage renal disease in many patients. Therefore, new therapeutic strategies targeting different pathophysiological mechanisms are needed. This review article briefly summarizes the standard therapy for diabetic nephropathy and also describes recent advances in potential renoprotective agents that could be used to prevent the development or progression of diabetic nephropathy.
Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies* ; Humans ; Kidney Failure, Chronic ; Renal Insufficiency ; Renal Insufficiency, Chronic

OBJECTIVE: To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. METHODS: Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin II receptor blocker (ACEI/ARB) were collected. RESULTS: A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05]. CONCLUSIONS Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.
Blood Glucose ; Creatinine ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Humans ; Prospective Studies

In diabetes mellitus, thickening of basement membrane in capillaries and small vessels is a well-known finding and important in the progression of diabetic microangiopathy. We evaluated whether the plasma levels of type IV collagen and fibronectin, which are important factors of basement membrane, are related with the presence of diabetic microangiopathy. Plasma type IV collagen and fibronectin levels were measured in 40 healthy controls (Mean +/- SD, age; 50.3 +/- 5.5 yr) and 94 diabetic patients (age; 52.4 +/- 13.5 yr) with and without microvascular complications. The mean plasma levels of type IV collagen (5.3 +/- 2.9 ng/ml) and fibronectin (474.4 +/- 119.4 ug/ml) in diabetic patients were significantly higher (p < 0.01) than in healthy controls (3.7 +/- 1.3 ng/ml and 319 +/- 50.9 ug/ml). The mean plasma level of type IV collagen in diabetic patients with complications (6.6 +/- 3.7 ng/ml) was significantly higher (p < 0.01) than in those without complications (4.3 +/- 1.7 ng/ml) and became higher in more complicated patients. Furthermore, the severity of retinopathy and several indicators of nephropathy such as serum BUN, creatinine and proteinuria were closely associated with plasma type IV collagen level and a significant correlation was found between plasma type IV collagen and creatinine clearance (r = -0.31, p < 0.001). There was no significant difference in plasma fibronectin concentrations, however, between the diabetic patients with complications and those without complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult ; Aged ; Biological Markers/blood ; Blood Proteins/urine ; Blood Urea Nitrogen ; Collagen/*blood ; Creatinine/blood ; Diabetic Angiopathies/*blood/diagnosis ; Diabetic Nephropathies/blood/diagnosis ; Diabetic Retinopathy/blood/diagnosis ; Female ; Fibronectins/*blood ; Human ; Male ; Middle Age

BACKGROUNDHepcidin, as a regulator of body iron stores, has been recently discovered to play a critical role in the pathogenesis of anemia of chronic disease. Atherosclerotic cardiovascular disease is the most common complication and the leading cause of death in chronic hemodialysis (CHD) patients. In the current study, we aimed to explore the relationship between serum hepcidin and uremic accelerated atherosclerosis (UAAS) in CHD patients with diabetic nephropathy (CHD/DN).

METHODSA total of 78 CHD/DN and 86 chronic hemodialyzed nondiabetic patients with chronic glomerulonephritis (CHD/non-DN) were recruited in this study. The level of serum hepcidin-25 was specifically measured by liquid chromatography-tandem mass spectrometry. Serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay.

RESULTSHigh serum level of hepcidin-25 was seen in CHD patients. Serum hepcidin-25 in CHD/DN was significantly higher than that in CHD/non-DN patients. Serum hepcidin-25 was positively correlated with ferritin, high-sensitivity C-reactive protein (hs-CRP), TNF-α, and IL-6 in CHD/DN patients. CHD/DN patients exhibited higher common carotid artery intima media thickness (CCA-IMT), hs-CRP, and hepcidin-25 levels than that in CHD/non-DN patients. Moreover, in CHD/DN patients, CCA-IMT was positively correlated with serum hepcidin, hs-CRP, and low-density lipoprotein-cholesterol. On multiple regression analysis, serum hepcidin and hs-CRP level exhibited independent association with IMT in CHD/DN patients.

CONCLUSIONSThese findings suggest possible linkage between iron metabolism and hepcidin modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.

Adult ; Aged ; Atherosclerosis ; blood ; Diabetic Nephropathies ; blood ; therapy ; Female ; Hepcidins ; blood ; Humans ; Male ; Middle Aged ; Renal Dialysis ; Young Adult

OBJECTIVES: In diabetics the disturbance of circardian variation of blood pressure and heart rate has been supposed to be related to diabetic autonomic neuropathy and diabetic nephropathy. We performed this study to evaluate the circardian variation of blood pressure and heart rate and the difference of affecting factors between normoalbuminuric patients and microalbuminuric patients. METHODS: We studied 50normotensive NIDDM patients without overt nephropathy, divided two grooups, which are normoalbuminuric patients(D1 group) and microalhuminuric patients(D2 group), according to the urinary albumine excretion rate(AER) on 24-h urine collection. We simultaneosly measured 24-hour blood pressure and heart rate by using of ambulatory 24-hour blood pressure monitoring (ABPM). RESULTS: 1) In group Kb, 24-h systolic and diastolic blood pressure were significantly higher than in C(normal control group) and D1 2) 24-h heart rate values did not significantly differ between the groups, but night heart was significantly elevated in group D2 than C and D1. 3) The night/day ratio of SBP(systolic blood pressure) and HR(heart rate) was significantly higher in D2 than C and D1, but the night/day ratio of DBP(diastolic blood pressure) was significantly higher in D2 compaired with C only. 4) The night/day ratio of SBP correlated significantly with duration of diabetes, log of AER, HDL, HbAlc and 24-h DBP. The determinants selected in a multiple stepwise regression were duration of diabetes and HbAlc. 5) The night/day ratio of DBP was related to duration of diabetes, log of AER, 24-h DBP and night HR. The determinants selected in a multiple stepwise regression were duration of diabetes and 24-h DBP. 6) The night/day ratio of HB was related to neuropathy, 1/creatinine, HDL, night SBP, duration of diabetes and log of AER. The determinants selected in a multiple stepwise regression were neruopathy and night SBP. CONCLUSION: In this study, the normal circardian variation of blood pressure was disturbed in a group of micoralbuminuric patients. But it seems that AER was not a principle independent factor and circardian variation of blood pressure and heart rate were affected by different several factors identified in this study. The nocturnal heart rate was significantly elevated in microalbuminuric group, suggesting the possibility of the presence of parasympathetic neuropathy which is supposed to be related with sudden cardiac death. So it is thought that blunted circardian variation of blood pressure and heart rate can be a prognostic indicator and further prospective study is necessary.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure Monitors ; Blood Pressure* ; Death, Sudden, Cardiac ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Neuropathies ; Heart ; Heart Rate ; Humans ; Urine Specimen Collection