Development, Worsening, and Improvement of Diabetic Microangiopathy in Older People: Six-Year Prospective Study of Patients Under Intensive Diabetes Control

Authors

  • Masafumi Katakura PhD,

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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  • Motoji Naka PhD,

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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  • Teruki Kondo PhD,

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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  • Mitsuhisa Komatsu PhD,

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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  • Keishi Yamauchi PhD,

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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  • Kiyoshi Hashizume PhD,

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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  • Toru Aizawa PhD

    1. From the *Department of Internal Medicine, Chikuma-Chuo Hospital, Chikuma, JapanDepartment of Internal Medicine, Asama General Hospital, Saku, JapanDepartment of Internal Medicine, Nagano-Chuo Hospital, Nagano, Japan§Department of Aging Medicine and GeriatricsCenter for Medical Education, Shinshu University School of Medicine, Matsumoto, Japan.
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Address correspondence to Toru Aizawa, PhD, Center for Medical Education, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan 390–8621. E-mail: taizawa@sch.md.shinshu-u.ac.jp

Abstract

OBJECTIVES: To examine retinopathy and nephropathy in elderly patients with diabetes mellitus (DM) under intensive multifactorial DM control.

DESIGN: Six-year interventional observation study.

SETTING: Multicenter study including four hospitals.

PARTICIPANTS: Four hundred thirteen elderly (≥65) patients with type 2 DM attending each hospital for 1 year or longer; those receiving hemodialysis or with uncured malignancy were excluded.

MEASUREMENTS: Development, worsening, and improvement of retinopathy and nephropathy and respective risk factors.

RESULTS: The mean baseline hemoglobin (HbA1c), blood pressure (BP), and total cholesterol were 6.8%, 137/74 mmHg, and 5.13 mmol/L, respectively. Retinopathy developed in 45 of 168 (27%) patients and, of 63 with nonproliferative retinopathy, worsened and improved in 11 (17%) and 23 (37%), respectively. Nephropathy developed in 53 of 227 (23%) patients and improved in 13 of 51 (25%) having it baseline. The mean change in glomerular filtration rate (ΔGFR, baseline GFR–GFR at the end of the study period) in those with nephropathy at baseline was 21.5 mL/min. HbA1c was related to development of retinopathy (P=.001, odds ratio (OR)=1.91), and serum creatinine (P=.03, OR=1.02), systolic BP (SBP) (P=.03, OR=1.22), and prior stroke (P=.005, OR=3.21) were related to development of nephropathy. In patients with nephropathy at baseline, SBP (P=.03, Spearman's rho (ρ)=0.310), total cholesterol (P=.01, ρ=0.361), and low-density lipoprotein cholesterol (P=.03, ρ=0.322) were correlated with ΔGFR.

CONCLUSION: In elderly patients under intensive control for DM, the outcome of microangiopathy is favorable. Modifiable risk factors were hyperglycemia for development of retinopathy and hypertension and hypercholesterolemia for development or worsening of nephropathy; prior stroke was an unmodifiable risk factor for development of nephropathy.

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