E Chantelau1. 1. Medical Department, Heinrich-Heine-Universität, Düsseldorf, Germany.
Abstract
BACKGROUND: Acute reduction of chronic hyperglycaemia can accelerate early diabetic retinopathy. In adolescent patients with Mauriac's syndrome, this phenomenon is related to an upregulation of subnormal serum IGF-1 levels. AIM: To obtain longitudinal data on serum IGF-1 and retinopathy status in poorly controlled adult insulin dependent (type 1) diabetic patients without Mauriac's syndrome, in whom hyperglycaemia is reduced by intensive insulin therapy. METHODS: Four patients with chronic severe insulin deficiency and early micro-angiopathy were studied prospectively. Changes in plasma glucose, HbA1c, serum IGF-1 levels, proteinuria, retinopathy, and clinical status were followed up closely. RESULTS: Reducing hyperglycaemia from > 16 mmol/l (equivalent to HbA1c > 11%) to < 10 mmol/l (HbA1c < 8%) within 5 months increased serum IGF-1 levels by 70-220%. While proteinuria and symptomatic neuropathy regressed, retinopathy progressed from the mild to the severe non-proliferative stage with maculopathy (n = 4), and to the proliferative stage (n = 1). Laser coagulation was commenced upon the appearance of sight threatening macular oedema (n = 4). CONCLUSION: Upregulation of serum IGF-1 preceding retinal deterioration in these patients suggests a cause-effect relation, consistent with earlier experimental and clinical data.
BACKGROUND: Acute reduction of chronic hyperglycaemia can accelerate early diabetic retinopathy. In adolescent patients with Mauriac's syndrome, this phenomenon is related to an upregulation of subnormal serum IGF-1 levels. AIM: To obtain longitudinal data on serum IGF-1 and retinopathy status in poorly controlled adult insulin dependent (type 1) diabeticpatients without Mauriac's syndrome, in whom hyperglycaemia is reduced by intensive insulin therapy. METHODS: Four patients with chronic severe insulin deficiency and early micro-angiopathy were studied prospectively. Changes in plasma glucose, HbA1c, serum IGF-1 levels, proteinuria, retinopathy, and clinical status were followed up closely. RESULTS: Reducing hyperglycaemia from > 16 mmol/l (equivalent to HbA1c > 11%) to < 10 mmol/l (HbA1c < 8%) within 5 months increased serum IGF-1 levels by 70-220%. While proteinuria and symptomatic neuropathy regressed, retinopathy progressed from the mild to the severe non-proliferative stage with maculopathy (n = 4), and to the proliferative stage (n = 1). Laser coagulation was commenced upon the appearance of sight threatening macular oedema (n = 4). CONCLUSION: Upregulation of serum IGF-1 preceding retinal deterioration in these patients suggests a cause-effect relation, consistent with earlier experimental and clinical data.
Authors: Tiffany Y Kim; Ann V Schwartz; Xiaojuan Li; Kaipin Xu; Dennis M Black; Dimitry M Petrenko; Lygia Stewart; Stanley J Rogers; Andrew M Posselt; Jonathan T Carter; Dolores M Shoback; Anne L Schafer Journal: J Bone Miner Res Date: 2017-08-09 Impact factor: 6.741
Authors: Subramanyam N Murthy; Sergiy Sukhanov; Jennifer McGee; Joel A Greco; Surabhi Chandra; Patrice Delafontaine; Philip J Kadowitz; Dennis B McNamara; Vivian A Fonseca Journal: Mol Cell Biochem Date: 2009-04-10 Impact factor: 3.396
Authors: Johan Wadén; Carol Forsblom; Lena M Thorn; Daniel Gordin; Markku Saraheimo; Per-Henrik Groop Journal: Diabetes Date: 2009-08-03 Impact factor: 9.461