Clinical Medicine Insights: Endocrinology and Diabetes

Ken-ichi Miyoshi, Takafumi Okura, Tomoaki Nagao, Masanori Jotoku, Daijiro Enomoto, Jun Irita, Mie Kurata and Jitsuo Higaki

Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine.

Abstract

Background:  Diabetic nephropathy is a progressive disease that leads to renal failure and end stage renal disease. A frequent and early manifestation of diabetic nephropathy is hyaline arteriolosclerosis. The noninvasive method for estimating the severity of arteriolosclerosis is measurement of the renal resistive index (RI). In this study, we determined whether or not normal blood glucose control, classified as an HbA1c  5.8%, was a sufficiently low level to prevent arteriolosclerosis in patients with essential hypertension.

Methods: The study subjects were 93 patients with essential hypertension with HbA1c levels 5.8%. Patients with a history of medication for diabetes mellitus were excluded. Blood flow velocity of the renal interlobar arteries was assessed by a Doppler ultrasonography and the RI calculated.

Results:  RI correlated positively with age, body mass index, pulse pressure, pulse rate and HbA1c, and negatively with diastolic blood pressure. A multivariate analysis identified age, pulse pressure and HbA1c as significant independent determinants of RI. Our data show that RI correlates with HbA1c independent of other variables, even in normoglycemic patients with HbA1c levels 5.8%.

Conclusions:  The results of this cross-sectional study suggest that blood glucose levels should be kept as low as possible in order to prevent arteriolosclerosis in the kidney in hypertensive patients.

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