Factors associated with diabetic microangiopathy: a study of 157 type I (insulin-dependent) diabetic patients

The relation between poor glycemic control and the development of diabetic microangiopathy has long been recognized. However hyperglycemia alone cannot account for the striking heterogeneity of diabetic patients regarding the presence or absence of microangiopathic lesions. This study was therefore designed to determine the prevalence of retinopathy, nephropathy, and neuropathy, and to identify the factors respectively associated with these lesions. In 157 patients with type I (insulin-dependent) diabetes, the following parameters were recorded: sex, age, duration of diabetes, body mass index, fasting plasma glucose, HbA1c, blood pressure, antihypertensive treatment, tobacco consumption, urinary albumin excretion, plasma creatinine, and presence of retinopathy and neuropathy. One-half of these patients had retinopathy, 32% neuropathy, and 29% nephropathy. Patients with nephropathy exhibited concomitantly high prevalences of retinopathy (69%) and neuropathy (49%). Among patients with retinopathy, 39% had nephropathy; 79% of those with neuropathy had concomitant retinopathy. For each microangiopathic localization, patients with the disease had significantly higher values (p less than 0.05) than those without for duration of diabetes, prevalence of hypertension, and systolic blood pressure. Stepwise logistic regression analysis showed that the following were independent predictive factors of each localization: for nephropathy, systolic blood pressure; for retinopathy, duration of diabetes; and for neuropathy, duration of diabetes, age, and HbA1c.