Increased annual visit-to-visit variability in systolic (SBP) and diastolic blood pressure (DBP) increases the risk for nephropathy, but not retinopathy, in patients with Type 1 diabetes, show study findings.

Exposure to hyperglycemia only explains around 11% of the risk for microvascular complications in patients with Type 1 diabetes, say the researchers. The other 89% must be explained by other factors, one of which is thought to be hypertension, they add.

Eric Kilpatrick (Hull Royal Infirmary, UK) and co-workers therefore investigated the possible contribution of high and variable BP on risk for nephropathy and retinopathy in a group of 1441 individuals with Type 1 diabetes who participated in the Diabetes Control and Complications Trial (DCCT).

During a follow-up period of 9 years, mean SBP at baseline and annual variation (SD) in SBP both significantly predicted risk for albuminuria, with respective odds ratios (ORs) of 1.005 and 1.093 per 1 mmHg increase or change.

SD in DBP was also significantly predictive for nephropathy with an OR of 1.102 associated with each 1 mmHg change.

Of note, neither high mean values nor variation in SBP or DBP predicted risk for retinopathy in this study.

“In contrast to retinopathy, visit-to-visit variability in blood pressure consistently added to mean BP in predicting the risk of developing albuminuria among the patients participating in the DCCT,” write Kilpatrick and colleagues in the journal Diabetes Care.

“This observation could have implications for the management and treatment of blood pressure in patients with Type 1 diabetes,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Free abstract

Diabetes can be a difficult disease to deal with, as there are physical complications associated with the poor control of blood glucose. These complications are generally divided into short-term complications and long-term complications.

Short-term Complications

Short-term complications are the result of a blood glucose that’s either very low or very high. Low blood glucose (called hypoglycemia) can occur in minutes as a result of too much insulin, too much exercise, or too little food, but high blood glucose usually takes several hours to develop. Whereas low blood glucose often can be managed at home, severe high blood glucose (called diabetic ketoacidosis) is an emergency that’s managed by medical staff in a hospital. Nevertheless, it’s important that you understand how it develops in order to prevent it.

Long-term Complications

Long-term complications can be devastating. It is much better to prevent long-term complications with careful diabetes management than to try to treat them after they develop. Fortunately, they generally take 15 or more years to fully develop, and there’s time to slow them down if not reverse them if you’re aware of them. All of the long-term complications of Type 1 Diabetes can be detected in the very earliest stages.

The long-term complications consist of eye disease known as retinopathy, kidney disease known as nephropathy, and nerve disease known as neuropathy. It is a little known fact that diabetes is the leading cause of new cases of blindness; new cases of kidney failure requiring dialysis, which cleanses the blood of toxins when the kidneys can no longer do their job; and loss of sensation in the feet as well as other consequences of nerve damage.

Not only does Type One Diabetes (T1DM) have short-term and long-term physical consequences, but as an autoimmune disease, Type One Diabetes (T1DM) is also associated with other autoimmune diseases such as celiac disease, an inflammation of the gastrointestinal tract; thyroid disease; and skin diseases.

As you might expect, people with Type One Diabetes also have significant psychological and emotional needs. It’s important, first of all, to realize that Type One Diabetes has been present in some very high achievers. In addition, Type One Diabetes is not only a disease of the particular patient but also a disease of the entire family since all family members will be affected in one way or another.

If you’re the patient with Type One Diabetes, the people around you need to know that you have diabetes and how to help you when you can’t help yourself. Often people with the disease try to keep it secret, as though it’s a blot on their character. Remember Type One Diabetes isn’t your fault. There will be times when you may need the help of others, and it will be a whole lot easier for them to help you if they know about your condition and what to do in different circumstances.