Artikel
Hypertension and microalbuminuria in patients with type 2 diabetes mellitus 1997 - 2001
Hypertonie und Mikroalbuminurie bei Patienten mit Typ-2-Diabetes mellitus 1997 - 2001
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Autoren
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E. Jungmann
- St. Vinzenz Hospital Rheda-Wiedenbrück (Rheda-Wiedenbrück, D)
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J. Bolle
- St. Vinzenz Hospital Rheda-Wiedenbrück (Rheda-Wiedenbrück, D)
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C. Mertens
- St. Vinzenz Hospital Rheda-Wiedenbrück (Rheda-Wiedenbrück, D)
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U. Snelting
- St. Vinzenz Hospital Rheda-Wiedenbrück (Rheda-Wiedenbrück, D)
| Veröffentlicht: | 11. November 2004 |
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Gliederung
Text
Introduction
Because of the broad acceptance of the data of the UK Prospective Diabetes Study 1998 regarding the beneficial effects of tight blood pressure control on microangiopathic outcome parameters in type 2 diabetes mellitus, there was hope that treatment of microalbuminuria and control of hypertension in type 2 diabetic patients might improve in the years following its publication.
Methods
Potential changes in the rate of microalbuminuria and in the prevalence and/or effectiveness of antihypertensive treatment were examined in all patients referred to our clinic in 1997, 1999 and 2001 for initiation of insulin treatment because of secondary failure of oral antidiabetic treatment.
Subjects
We examined 272 patients' files. 75 patients were referred to our clinic in 1997, 106 patients in 1999 and 91 patients in 2001.
Results
Mean age decreased from 64 +/- 1 (average +/- SEM) in 1997 to 62 +/- 1 years in 2001 (p < 0.05), duration of diabetes from 9 +/- 1 to 7 +/- 1 years, Body mass index increased from 29.2 +/- 0.4 to 31.5 +/- 0.1 kg/m², HbA1c averaged consistently 9.8 +/- 0.2 % (upper limit of reference range, 5.7 %). The rate of increased urinary albumin excretion dropped from 59 % in 1997 to 53 % in 1999 and again increased to 59 % in 2001. The rate of antihypertensive treatment increased from 61 % in 1997 to 74 % in 1999 but dropped to 31 % in 2001 (p < 0.01). Systolic blood pressure increased steadily from 136 +/- 2 mmHg in 1997 to 140 +/- 2 mmHg in 2001 (p < 0.05). Diastolic blood pressure and creatinine levels in serum were unchanged. The rate of smoking averaged consistently about 20 %. The prevalence of diabetic neuropathy decreased from 69 % to 50 % (p < 0.05).
Conclusions
Against our hope that the control of blood pressure might have improved since 1997, there was a tendency to a more negligent approach to the treatment of hypertension in 2001. In type 2 diabetic patients with secondary failure of oral antidiabetic treatment the risk of eventually developing diabetic nephropathy or other microangiopathic diabetes complications is particularly increased. Therefore, it remains worth examining to which extent the well-defined treatment targets for hypertensive and/or microalbuminuric patients originating from the UKPDS experience or comparable treatment trials in type 2 diabetes mellitus may generally be implemented into treatment regimen in clinical practice.
