Relationship between Hyperglycemia and Diabetic Glomerulosclerosis
Uremia in diabetics as a result of progressive glomerulosclerosis accounts for one fourth of patients newly accepted in maintenance hemodialysis and renal transplant programs in the United States. Convincing evidence indicates that degenerative vasculopathy in the diabetic eye and glomerulus are a direct result of hyperglycemia and a function of duration of diabetes. Based on animal models of diabetes and clinical observations over the past few years, the thesis that careful control of blood glucose will preempt development of vasculopathy and correct abnormalities of intermediate metabolites and hormonal disturbances is increasingly accepted. Development of simplified methods of self-monitoring of blood glucose and of lightweight battery-powered insulin infusion systems has permitted study of nearly euglycemic diabetics for a year or longer. It can be anticipated that the lessons learned in recent advances in diabetic management will in sum improve well-being and retard development of vasculopathy. Mogenson,1 for example, has shown that control of hypertension in azotemic diabetics retards deterioration of glomerular filtration at the rate of 9 ml/min/year. Our preliminary experience suggests that, in addition to reduction of blood pressure, morbidity in renal transplanted and uremic diabetics can be further reduced by incorporating self-monitoring of blood glucose into the treatment regimen.
KeywordsBlood Glucose Diabetic Retinopathy Peritoneal Dialysis Renal Transplant Recipient Glomerular Basement Membrane
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