Nephropathy is delayed by intensified insulin treatment in patients with insulin‐dependent diabetes mellitus and retinopathy*

Reichard P, Rosenqvist U (Department of Internal Medicine II, The Southern Hospital, and Stockholm County Council Teaching Centre for Diabetes (LUCD). Stockholm, Sweden). Nephropathy is delayed by intensified insulin treatment in patients with insulin‐dependent diabetes mellitus and retinopathy. Patients with insulin‐dependent diabetes mellitus (IDDM) and non‐proliferative retinopathy were randomized to intensified conventional insulin treatment (ICT, n = 44) or regular treatment (RT, n = 51). During a 3‐year period the glycosylated haemoglobin (HbA1c) levels were reduced to a greater extent ( P = 0.00001) in the ICT group (from 9.5 ± 0.2 to 7.4%, P = 0.0001) than in the RT group (9.4 ± 0.2 to 9.0 ± 0.2. P = 0.004). The urinary albumin excretion rate (UAER) increased significantly ( P = 0.033) in the RT group but not in the ICT group, and the UAER differed significantly ( P = 0.031) between the groups after 3 years. The mean HbA1c values during the study period independently influenced the deterioration of UAER levels ( P = 0.029). Initial diastolic blood pressure ( P = 0.112). the HbA1c value at entry ( P = 0.480) and the smoking habits ( P = 0.959) were not related to change of UAER levels. Manifest nephropathy after 3 years was seen almost exclusively in patients with HbA1c levels above 9%. Improved blood glucose control, without ‘near normoglycaemia’, delayed the progression of nephropathy in patients with IDDM and retinopathy.