Microangiopathic complications in type 1 diabetes mellitus: differences in severity when isolated or associated with autoimmune polyendocrinopathies

Microangiopathic complications in type 1 diabetes mellitus: differences in severity when isolated or associated with autoimmune polyendocrinopathies

Author Monteagudo, Patrícia Teófilo Autor UNIFESP Google Scholar
Freire, Maria Beatriz Sayeg Autor UNIFESP Google Scholar
Moraes, Nilva Simeren Bueno de Autor UNIFESP Google Scholar
Dib, Sergio Atala Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract CONTEXT: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease.OBJECTIVE: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1).PATIENTS: OSAD (n=17) and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 ± 8.2 and 13.2 ± 5.9 years, respectively) and metabolic control (HbA1c: 6.4 ± 1.9 and 6.8 ± 1.4%).MAIN OUTCOME MEASURES: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. RESULTS: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 ± 2.5 vs. 17.3 ± 9.2 µg/min; p< 0.05). Nephropathy was detected in 12% of the OSAD (none of them macroproteinuric) and in 39% of the iDM1 . The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p< 0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29% of the OSAD and in 46% of the iDM1.CONCLUSIONS: OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1 , the increase in UAE of OSAD was not associated with reductions in GFR.

CONTEXTO: O desenvolvimento e evolução das complicações crônicas do diabetes mellitus podem apresentar diiferenças entre os vários tipos e condições desta doença. OBJETIVO: Avaliar o grau de microangiopatia em pacientes com diabetes mellitus do Tipo 1 (DM1) associado ( OSAD) ou não (DM1i) a endocrinopatias auto-imunes. PACIENTES: Os OSAD (n= 17) e os DM1i (n= 13) eram pareados para o tempo de duração do diabetes (13.9 ± 8.2 e 13.2 ± 5.9 anos, respectivamente) e controle metabólico (HbA1c: 6.4 ± 1.9 e 6.8 ± 1.4%). VARIÁVEIS ESTUDADAS: A excreção urinária de albumina (EUA), o inverso da creatinina sérica (1/C) e o grau de retinopatia diabética (oftalmoscopia indireta). RESULTADOS: A prevalência de hipertensão arterial foi semelhante nos grupos e os OSAD tinham níveis inferiores de EUA (7.4 ± 2.5 vs. 17.3 ± 9.2 µg/min; p< 0.05). A nefropatia diabética foi detectada em 12% dos OSAD (nenhum deles com macroproteinúria) e em 39% dos DM1i. Nos DM1i havia uma correlação inversa entre a EUA e o 1/C (r= -0,7, p< 0,005), o mesmo não ocorria no OSAD (r= 0,2, ns). Retinopatia em grau severo: 29% do OSAD e 46% do DM1i. CONCLUSÕES: O presente estudo sugere que os OSAD apresentam uma evolução melhor das microangiopatias quando comparado ao DM1i nas mesmas condições. Nos DM1i o aumento da EUA estava inversamente associada ao RFG e o mesmo não ocorria nos OSAD.
Keywords Microangiopathy
Type 1 diabetes mellitus
Autoimmune poliendocrinopathies
Language English
Date 1998-11-01
Published in São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 116, n. 6, p. 1866-1872, 1998.
ISSN 1516-3180 (Sherpa/Romeo)
Publisher Associação Paulista de Medicina - APM
Extent 1866-1872
Origin http://dx.doi.org/10.1590/S1516-31801998000600007
Access rights Open access Open Access
Type Article
SciELO ID S1516-31801998000600007 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/690

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