Type 1 diabetes, as an autoimmune disease, presents several islet cellspecific autoantibodies such as islet cell antibody (ICA), anti-insulin, anti-glutamic acid decarboxylase (GAD) and the antibody (Ab) against tyrosine phosphatase (PTP)-like protein known as ICA-512 (IA-2). In order to determine the frequency of the anti-GAD and anti-IA-2 autoantibodies in Brazilian type 1 diabetes patients we studied 35 diabetes mellitus (DM) type 1 patients with recent-onset disease (£12 months) and 37 type 1 diabetes patients with long-duration diabetes (>12 months) who were compared to 12 children with normal fasting glucose. Anti-GAD 65 and anti-IA-2 autoantibodies were detected with commercial immunoprecipitation assays. The frequency of positive results in recent-onset DM type 1 patients was 80.0% for GADAb, 62.9% for IA-2Ab and 82.9% for GADAb and/or IA-2Ab. The longduration type 1 diabetes subjects presented frequencies of 54.1% for GADAb and IA-2Ab, and 67.5% for GAD and/or IA-2 antibodies. The control group showed no positive cases. Anti-GAD and IA-2 assays showed a high frequency of positivity in these Brazilian type 1 diabetes patients, who presented the same prevalence as a Caucasian population.
Lack of the physiological nocturnal fall in blood pressure (BP) has been found in diabetics and it seems to be related to the presence of diabetic complications. The present study examined the changes in the nocturnal BP pattern of 8 normotensive insulin-dependent diabetic adolescents without nephropathy following improvement in glycemic control induced by an 8-day program of adequate diet and exercise. The same number of age-and sex-matched control subjects were studied. During the first and eighth nights of the program, BP was obtained by ambulatory BP monitoring. After a 10-min rest, 3 BP and heart rate (HR) recordings were taken and the mean values were considered to represent their awake values. The monitor was programmed to cuff insufflation every 20 min from 10:00 p.m. to 7:00 a.m. The glycemic control of diabetics improved since glycemia (212.0 ± 91.5 to 140.2 ± 69.1 mg/dl, P<0.03), urine glucose (12.7 ± 11.8 to 8.6 ± 6.4 g/24 h, P = 0.08) and insulin dose (31.1 ± 7.7 to 16.1 ± 9.7 U/day, P<0.01) were reduced on the last day. The mean BP of control subjects markedly decreased during the sleeping hours of night 1 (92.3 ± 6.4 to 78.1 ± 5.0 mmHg, P<0.001) and night 8 (87.3 ± 6.7 to 76.9 ± 3.6 mmHg, P<0.001). Diabetic patients showed a slight decrease in mean BP during the first night. However, the fall in BP during the nocturnal period increased significantly on the eighth night. The average awake-sleep BP variation was significantly higher at the end of the study (4.2 vs 10.3%, P<0.05) and this ratio turned out to be similar to that found in the control group (10.3 vs 16.3%). HR variation also increased on the eighth night in the diabetics. Following the metabolic improvement obtained at the end of the period, the nocturnal BP variation of diabetics was close to the normal pattern. We suggest that amelioration of glycemic control may influence the awake-sleep BP and HR differences. This effect may be due at least in part to an attenuated insulin stimulation of sympathetic activity. Correspondence
An inherited predisposition to hypertension may increase susceptibility to nephropathy in type I diabetes. We evaluated the influence of a family history of essential hypertension on albuminuria in normotensive, normoalbuminuric type I diabetic patients. Forty-two diabetics (12.9±2.04 years) were divided into three groups according to tertiles of albumin excretion rate (group 1,1.27+0.35; group 2, 2.43±0.49; group 3, 6.37±3.43 jig/min; P<.001). Familial hypertension was considered to be present if the patient had one parent or grandparent on antihypertensive therapy. The three groups did not differ concerning age, diabetes duration, insulin requirement, body mass index, blood pressure, and urinary glucose excretion. Albumin excretion rate did not correlate with any parameter studied. The frequency of hypertension was significantly lower among the relatives of the patients from group 1 compared with those from groups 2 and 3 (28.6% versus 64.3% versus 78.6%, P<.03). Our data suggest that a familial antecedent of hypertension in normoalbuminuric type I diabetic patients is associated with a high normal albumin excretion rate not related to increases in blood pressure. Early changes in renal hemodynamics, seen in patients with a predisposition to hypertension, may contribute to increments in albuminuria even within the normal range. (Hypertension. 1994^3[suppl I]:I-256-I-258.)Key Words • diabetes mellitus, insulin-dependent • hypertension, essential • albuminuria • diabetic nephropathies R ecent studies have suggested that an inherited predisposition to essential hypertension (EH) may increase susceptibility to nephropathy in insulin-dependent diabetes mellitus (IDDM) based on the following arguments: (1) Nondiabetic parents of IDDM patients with nephropathy have higher blood pressure than parents of patients without proteinuria 1 ; (2) the rates of sodium-lithium countertransport, a marker of risk for EH, 2 have been found to be elevated in IDDM patients in whom the renal disease was developing 3 -4 ; and (3) hyperactrvity of Na-Li countertransport is also observed in diabetic patients even before the onset of nephropathy and is associated with hyperfiltration. 5 In fact, the influence of familial antecedents for EH on renal hemodynamics and sodium handling was evidenced by the comparison of normotensive IDDM offspring of hypertensive and nonhypertensive parents.6 However, possible influences on urinary albumin excretion in those patients without nephropathy were not investigated.This study evaluated the influence of a familial predisposition to EH on the albumin excretion rate (AER) in normotensive normoalbuminuric IDDM patients. aged 12.9±2.04 years, participated in this study after their parents' consent was obtained. IDDM duration ranged between 1.5 and 12 years. All patients were normoalbuminuric (as defined by AER < 15 /ig/min) and normotensive. Blood pressure was considered normotensive when systolic levels were less than 130 and diastolic levels less than 85 mm Hg over three recordings using a sta...
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