Exercise as a provocative test in early renal disease in type 1 (insulin-dependent) diabetes: albuminuric, systemic and renal haemodynamic responses

Abstract

The value of exercise as a provocative test for early renal disease in Type 1 (insulin-dependent) diabetes was re-evaluated. Three carefully characterized groups of males were studied: 10 non-diabetic controls, 16 diabetic patients (group 1) with normal urinary albumin excretion (less than 15 micrograms/min) and 14 Albustix-negative diabetics (group 2) with increased urinary albumin excretion (15-122 micrograms/min). Assignment to a study group was made on the basis of three 24-h urine collections, and the groups were well matched for age, weight, height, and serum creatinine concentration. The two diabetic groups were similar with regard to duration of disease (13 +/- 6 versus 16 +/- 3 years), metabolic control (HbA1c: 8.4 +/- 1.4 versus 8.7 +/- 1.3%) and degree of diabetic complications (beat-to-beat variation and retinopathy). An exercise protocol of 450 and 600 kpm/min workloads was employed. In the resting state group 2 patients had elevated systolic blood pressure compared with the normal subjects (132 +/- 13 versus 119 +/- 9 mmHg), and their glomerular filtration rate was significantly reduced compared with group 1 (123 +/- 19 versus 138 +/- 15 ml/min per 1.73 m2, p less than 0.05). During exercise the urinary albumin excretion rate increased significantly in all three groups (normal subjects: 6 +/- 0.7 to 8 +/- 1.3 (microgram/min); group 1: 6 +/- 0.6 to 9 +/- 1 microgram/min and group 2: 48 +/- 10 to 113 +/- 23 micrograms/min), the relative increase being higher in group 2 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)