Non-insulin-dependent diabetes mellitus is strikingly common in British Indians, but their susceptibility to diabetic complications is unknown. The ratio of albumin to creatinine concentrations was measured in samples of the first urine voided in the morning in 154 Indian and 82 Europid patients with non-insulin-dependent diabetes and in a control group of 129 non-diabetic Indians. The ratio was significantly higher in the Indian patients than in the Europid patients and the Indian controls. There were no significant correlations between the logarithm of the albumin: creatinine ratio and age, known duration ofdiabetes, haemoglobin A1 concentration, or body mass index within either diabetic group. Hypertension and raised albumin:creatinine ratio were significantly associated, and significant correlations were seen between the logarithm of the albumin:creatinine ratio and systolic and diastolic blood pressures in the Indian but not the Europid diabetics.

GLA had a beneficial effect on the course of diabetic neuropathy.

No abstract

Prospective studies have shown that increased urinary albumin excretion is a risk factor for cardiovascular morbidity and mortality in patients with Type 2 diabetes mellitus, but the nature of the association remains unknown. Eighty-five patients aged less than 65 years and not treated with insulin were studied. The overnight albumin excretion rate (AER) was measured in each patient and analysed in relation to several putative risk factors for cardiovascular disease. AER was used both as a continuous variable and after dividing patients into high-risk (AER greater than or equal to 10 micrograms min-1) and low-risk (AER less than 10 micrograms min-1) groups. By both methods of analysis AER was significantly correlated with both seated and supine diastolic blood pressure levels and with resting heart rate. Body mass index and waist-hip ratio appeared higher and HDL-cholesterol lower in the at-risk group, but differences were not statistically significant. The level of Factor VII was not significantly lower in the at-risk group. Little of the cardiovascular risk associated with raised AER can be attributed to associations with conventional risk factors.

SummaryThe retinal vessel calibre responses to systemic sympathetic stimulation, were studied in 22 ran domly selected diabetic patients (mean age ± SEM: 54.7 ± 2.59 years, range 25-73; 13 IDDM, 9 NIDDM; 4 females), using sustained isometric muscle contraction as the stimulus. At a diffe rent session the integrity of the autonomic nerve function in these diabetic patients was assessed using 3 standard tests of autonomic nerve function, based on cardiovascular reflexes. Diabetic patients with an intact autonomic nervous system: Group 1, (n=l1, mean age: 54.9 ± 4.55 years, 7 IDDM 4 NIDDM) showed a mean arteriolar constriction of 9.2% (SEM 2.89, p0.05) and venule constriction of 2.1 % (SEM 1.38, p>0.05); for a mean rise in diastolic blood pressure of 19.8 mmHg (SEM 4.49, range: 2-50). There was no correlation between the rise in diastolic blood pressure and the retinal arteriolar constriction in the 2 groups (Group 1: r=0.45, p>O.l and Group 2: r=0.56, p>0.05). Duration, type and con trol of diabetes were not significantly different between the 2 groups. The severity of retinopathy was slightly worse in Group 2 compared to Group 1. These results point to an association between autonomic neuropathy and failure of regulation of retinal blood flow.Autoregulation of the microcirculation is a well recognised phenomenon! and has been demonstrated in the retinal circulati�n. 2 Neurogenic, myogenic and humoral factors may be involved in the homeostatic mainte nance of the retinal blood flow during changes in perfusion pressure, however, the definitive mechanism has not been estab lished. Recently, a significant association has been demonstrated between retinal vessel calibre and systemic autonomic nerve stimu lation, with consistent responses of the reti nal vasculature to generalised sympathetic nerve stimulation.3 These results are particulady relevant to patients with diabetes, as diabetes mellitus is the commonest cause of autonomic neuropathy in the United King dom;4 20-40% of diabetics have evidence of autonomic nerve dysfunction on initial pre sentation. 5•6 Several studies have shown a sig nificant association between autonomic nerve dysfunction and retinopathy in patients with diabetes mellitus.7-9 Cardiovascular autonomic neuropathy has been demonstrated in 75% of diabetic patients with proliferative retinopathy7 and ocular autonomic neuropathy (involving the anterior segment of the eye) in 57% of this Correspondence to: Research