gms | German Medical Science

Introduction: The beneficial effects of tight blood pressure control on microalbumiuria and other microangiopathic outcome parameters in type 2 diabetes mellitus are beyond doubt. Therefore, there was hope that in clinical practice, the control of hypertension in type 2 diabetic patients might also improve.

Methods: Potential changes in the prevalence of microalbuminuria or in the effectiveness of antihypertensive treatment were examined in all insulin-naive patients referred to our clinic in 1997 - 2003 for initiation of insulin treatment.

Subjects: 365 patients' files were examined.

Results: Mean age decreased from 64 +/- 1 (average + SEM) in 1997 to 62 +/- 1 years in 2003, duration of diabetes from 9 +/- 1 to 6 +/- 1 years, body mass index increased from 29.2 +/- 0.3 to 30.3 +/- 0.5 kg/m²,. The rate of increased urinary albumin excretion dropped from 59 % to 42 % (all p < 0.05). The rate of antihypertensive treatment increased from 61 % to 75% (p < 0.01). Systolic blood pressure decreased from 136 +/- 2 mmHg to 133 +/- 2 mmHg (p < 0.05). Diastolic blood pressure and creatinine levels in serum were unchanged. The prevalence of diabetic neuropathy decreased from 69 % to 53 % (p < 0.05).

Conclusions: Corresponding to our hope that the control of blood pressure might have improved since 1997, there was a clear-cut tendency to a more persistent approach to the treatment of hypertension between 1997 and 2003 in our type 2 diabetic patients. Therefore, there appears to be a realistic chance that more strict treatment targets for hypertensive and/or microalbuminuric patients with type 2 diabetes mellitus will at last be implemented into treatment regimen in clinical practice.