Effect of Control of Blood Glucose on Urinary Excretion of Albumin and β2Microglobulin in Insulin-Dependent Diabetes

Abstract
To study the effects of improved control of blood glucose on markers of renal glomerular and tubular function, we initially determined, by radio-immunoassay technics, urinary excretion rates of albumin and β2 microglobulin in 17 nondiabetic subjects and in 43 insulin-dependent, clinically nonproteinuric diabetic patients. Duration of diabetes ranged from six months to 39 years, and the patients were studied while receiving conventional therapy. Mean urinary albumin excretion was significantly elevated in the diabetics, but β2-microglobulin excretion rates were not different from those of the controls, suggesting that the increased albumin excretion was due to increased transglomerular loss of albumin. Seven patients with long-term diabetes (duration of six to 33 years), selected because of elevated albumin excretion, were studied before and during a continuous, subcutaneous insulin infusion for a period of one to three days. Urinary albumin excretion was significantly reduced during the insulin infusion, but mean β2-microglobulin excretion did not change. Strict control of blood glucose, even in the short term, may reverse a functional renal abnormality in long-duration, insulin-dependent diabetes. (N Engl J Med 300:638–641,1979)