Increased urinary albumin excretion is a marker of risk for retinopathy and coronary heart disease in patients with type 2 diabetes mellitus.

The prevalence of increased urinary albumin excretion (UAE) (micro- and macroalbuminuria) and its association with diabetic retinopathy (DR) (evaluated by fluorescent angiography), coronary heart disease (CHD), and various related risk factors were studied in 320 type 2 diabetic patients. In this subsample of type 2 diabetic patients, microalbuminuria was present in 15% of the patients; macroalbuminuria in 4.8%, CHD in 9.9%, DR in 53.4%, and arterial hypertension in 46%. UAE was independently related to CHD (P < 0.05), retinopathy (P < 0.001), hypertension (P < 0.001), and triglycerides (P < 0.02). We conclude that increased UAE is associated to a greater frequency of retinopathy and CHD in type 2 diabetic patients.

Effects of synthetic salmon calcitonin administration on gastrin, immunoreactive insulin and growth hormone release after protein meal in uremic patients.

Recent studies indicate that calcitonin inhibits, in man, the secretion of several hormones such as gastrin, insulin, growth hormone. There are no reports about this effect in uremic patients in which frequently calcitonin, gastrin, growth hormone, and insulin response to glucose administration is increased. A comparative study of the effects of synthetic salmon calcitonin infusion (50 U iv) on gastrin, growth hormone and insulin release protein meal (250 g of boiled lean beef) in 10 uremic patients undergoing hemodialysis and in 10 normal subjects was performed. Insulin and growth hormone response to protein meal was inhibited by calcitonin both in normal and uremic subjects. Gastrin response instead was inhibited only in normal subjects. These findings indicate that in uremic patients the inhibitory effect of calcitonin on insulin and growth hormone secretion is still present. The lack of evident inhibitory effect on gastrin release could be related to persistent hypergastrinemia because of the increased half life of the hormone which could mask acute changes of secretion.

Microalbuminuria and severity of diabetic retinopathy in type 1 diabetic patients: association and relationship with some risk factors.

To investigate the relationship between microalbuminuria and severity of retinal damage, we studied 86 Albustix-negative insulin-dependent diabetic patients whose disease duration was more than 5 years (age 31.9 +/- 10.9 years; duration 14.7 +/- 7.1 years). Retinopathy was evaluated by fluorescein angiography in four groups of patients: a) 37 (43%) without retinopathy, b) 29 (34%) with background retinopathy, c) 10 (12%) with pre-proliferative retinopathy and d) 10 (12%) with proliferative retinopathy. Microalbuminuria (urinary albumin excretion > 30 mg/24 h) was calculated from timed 24-h urine collection and measured by a radioimmunoassay method. Microalbuminuria was found in 20 patients (23%); 16 of whom showed both retinopathy and microalbuminuria. Diabetic retinopathy was more frequent than microalbuminuria (57% vs 23%). The prevalence of microalbuminuria was significantly higher in the proliferative retinopathy group compared to the group without retinopathy (p < 0.0005) and the background retinopathy group (p < 0.007). The frequency of diabetic retinopathy was significantly higher (p < 0.04) in patients with than without microalbuminuria. These results indicate that microalbuminuria is associated with the presence and severity of diabetic retinopathy in insulin-dependent diabetic patients.