- Relationship Among Urinary Glycosaminoglycan (GAG) Excretion Rates, Urinary Albumin Excretion and Macrovascular Disease in Patients with Type 2 Diabetes Mellitus.
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Yoon Sang Choi, Sang Hoon Kim, Hyang Kim, Yun Kyung Cho, Hyun Ju Um, Si Yong Kim, Byong Ik Kim, Yoo Lee Kim, Hwa Young Lee, Sang Jong Lee
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Korean Diabetes J. 2000;24(2):245-255. Published online January 1, 2001
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 Abstract
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- BACKGROUND
Increased loss of proteoglycan (PG) from glomerular basement membrane (GBM) has been postulated to alter glomerular charge selectivity which contributes to urinary loss of albumin. The glycosaminoglycan (GAG) is the degradation products of PG. Recently, one of the hypothesis suggested that urinary albumin execretion(UAE) reflects not only merely a glomerular manifes-tation but also a macrovascular disease (by Deckert et al), Wasty et al. reported a significant decrease in total GAG concentration and marked changes in their distribution in atherosclarotic plaques in human. Thus, the alterations in the metabolism of GAG might play a role in the pathogenesis of diabetic macroangiopathy. Therefore, we investigated the relationship among urinary GAG execretion rates, UAE and macrovascular disease in patients with type 2 diabetes mellitus. METHODS: We measured urinary excretion rates of GAS in type 2 diabetic patients with and without macrovascular disease ( cerebrovascular disease, ischemic heart disease and other peripheral vascular disease ) and investigated the relationships among urinary execretion of GAG, UAE and macrovascular disease in 103 patients with type 2 diabetes mellitus. RESULTS: 1) Among total 103 patients, 66 patients (64.0%) showed normoal-buminuria, 18 patients (17.5%) showed microabluminuria and 19 paitents (18.4%) showed macro albuminuria respectively. The duration of diabetes mellitus and the prevalence of hypertension, diabetic retinopathy and macrovascular disease were increased according to the degree of UAE. 2) The urinary excretion rates of GAG in type 2 diabetes mellitus with normo-, microand macro-albuminuria were 6.72+/-4.05, 9.17+/-3.26 and 14.20+/-6.13 microgram glucuronic acid/min respectively (p<0.05). The urinary GAG levels were significantly correlated with UAE (r=0.43, p<0.05). 3) The urinary excretion rates of GAG in type 2 diabetes mellitus with (n=26) and without (n=77) macrovascular disease were 6.21+/-2.75 and 9,31+/-5.59 ug glucuronic acid/min, respectively (p<0.05). CONCLUSION: 1) The urinary excretion rates of GAG were decreased in patients with macro vascular complications of type 2 diabetes mellitus. 2) The urinary excretion rates of GAG may be a possible marker of macrovascular disease in type 2 diabetes mellitus. Yet, further large prospective studies are necessary to confirm our findings.
- Relationship between Circadian Mean Blood Pressure ( MBP ) Rhythm and Microvascular Complications in Normotensive NIDDM Patients.
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Hyang Kim, Seong Chun Shim, Dae Jung Shim, Hi Moo Lee, Yoon Sang Choi, Jin Ho Kang, Byung Ik Kim, Sang Jong Lee, Yoo Lee Kim, Yoon Kyung Cho
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Korean Diabetes J. 1998;22(4):552-560. Published online January 1, 2001
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Abstract
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- BACKGROUND
Thanks to ambulatory 24-h blood pressure monitoring device, it became possible to investigate circadian pressure rhythm under variable physiologic and pathologic conditions. Moreover, ambulatory 24-h blood pressure has allowed us to detect in diabetic patients unsuspected abnormalities of the blood pressure circadian rhythm and to relate them to autonomic or renal dysfunction. This study was designed to evaluate the relationship between circadian rhythm of mean blood pressure (MBP) and microvascular complications in patients with noninsulin-dependent diabetes mellitus (NIDDM). METHODS: 24hr blood pressure monitoring was applied to 63 normotensive NIDDM patients(mean age 55.3+7.2 year, male: 35, female: 28) who have been hospitalized at our hospital from March 1993 to December 1994 to measure systolic, diastolic and hourly mean pressure of daytime, night time and 24hr. In addition, NIDDM patients were divided into 2 groups according to 24 hour circadian blood pressure rhythm by measuring hourly mean pressure. These 2 groups, group 1 who had a circadian MBP rhythm, with a peak value in the afternoon and group 2 who had an absent or reversed circadian rhythm with a peak value during the night time, were observed to evaluate the frequency of diabetic microvascular complication. RESULTS: The mean systolic and diastolic ambulatory BP values were significantly higher in the group 2 NIDDM during night-time compared with control group and group 1(systolic pressure: F=12.53 p<0.05 diastolic pressure: F:=15.159 p<0.05). Although there was no significant differences in day-time heart rate between three groups, 1 and 2 group showed significant higher level of night-time heart rate comparing with that of control group (F=3.444 p<0.05). Group 2 diabetes patients showed, both systolic and diastolic, higher night-time and day-time blood pressure ratio(systolic pressure: F=35.958 p<0.05> diastolic pressure F=40.126 p<0.05). Observing the night-time and day-time heart rate ratio, group 1 and 2 patients showed significantly higher level compared with that of cantrol group(F=12.144 p<0.05). Regarding the retmopathy, group 1 patient.; showed mild degree retinopathy or normal finding(X =3.65 p<0.05). However, many group 2 patients showed moderate 2 degree nonproliferative retinopathy(X =3.23 p<0.05). The prevalence of overt nepkuopathy (24-hour urine protein>500mg) and autonomic neuropathy (postural and abnormal E:I ratio during deep breathing test) was significantly higher in group 2 (overt nephropathy: X'=3.23 p
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