Near-normoglycemia and late diabetic complications. The Oslo Study

Abstract

A fast and precise method for routine, large scale measurements of HbA1, with elimination of pre-Alc, was established. Near normal blood glucose levels were obtained during treatment with CSII and MI; significantly better than during conventional treatment with two daily injections of mixed regular/intermediate insulin. On most parameters of glycemic control, CSII was slightly better than MI (n.s.). The frequency of hypoglycemic coma was significantly reduced, but blood glucose values below 2.5 mmol/l were more frequent on CSII, compared to conventional treatment. The frequency on MI was similar to that of conventional treatment. CSII patients have an increased risk of developing ketoacidosis by accidental cessation of insulin infusion, and of developing cutaneous infections at the infusion site. Insulin antibodies increased during one year of CSII and MI, when compared to conventional treatment. Rapid tightening of blood glucose control may lead to transient deterioration of retinopathy, mainly by the occurrence of cotton wool spots. Patients who already have background retinopathy are at higher risk for such changes. A significant increase in the number of microaneurysms and haemorrhages was observed on conventional treatment whilst no significant change was found on CSII and MI. Less progression of retinopathy (elevated by fluorescein angiograms) was observed on CSII and MI (n.s.) when compared to conventional treatment. Thus long term near-normoglycemia may retard the progression of early retinopathy. Urinary albumin excretion was reduced during CSII and MI (n.s.), but no change was observed during conventional treatment. Glomerular hyperfiltration improved during intensified treatment. Motor nerve conduction velocity deteriorated on conventional treatment, but improved during CSII. No change occurred on MI.