Non-insulin-dependent Diabetes Mellitus Patients With Diabetic Nephropathy Stage And Early Diabetic Nephropathy Pathophysiology And Clinical Research

We determined the urinary albumin excretion rate (AER) in 214 cases with NIDDM in our outpatient clinic in 1986. They were 73 males and 141 females and had the age of 40-70 years. We found that 36 cases had abnormaly high AER. After excluding the cases who were not able to join the study, We divided the cases with abnormal AER into 2 groups: (1) 15 cases with AER of 15-200 ug/min, and (2) 9 cases with AER of greater than 200 ug/min. They were in the microalbumin— uria (?)ange ( group 1) and the macroalbuminuria range (group 2) respectively as Mogensen proposed for the classification of AER for IDDM. We gave all these patients intensive education and careful treatment for 18 months, so that all cases had near normal HbA₁ and fasting plasma glucose and normal blood pressure after 6 months of treatment and maintained in this condition steadily. They had no urinary tract infection and negative urinary cultures, no hypertension and no congestive heart failure, no ketosis and no detectable non-diabetic renal diseases. During the period having satisfectory diabetic control with HbA₁ below 9.8% and fasting plasma glucose below 140 mg %, we repeated the AER determinations more than 3 times. The AER in all cases in group 1 and group 2 were still in the ranges of microalbu-minuria and macroalbuminuria respectively. Therefore, we considered that these cases had incipient diabetic nephro-pathy and clinical diabetic nephropathy respectively. For the purpose of further study, we selected 15 cases with normal AER at random with age, sex and duration of diabetes matched to cases with incipient diabetic nephropathy.