The Effect of Diabetic Control on the Width of Skeletal-Muscle Capillary Basement Membrane in Patients with Type I Diabetes Mellitus

Abstract

We studied the relation between the control of blood glucose and the width of skeletal-muscle capillary basement membrane in 23 insulin-dependent (Type I) diabetic patients. After initial measurement of levels of glycosylated hemoglobin and width of skeletal-muscle capillary basement membrane, the patients were divided into two groups: an experimental group of 13 patients who were treated with continuous subcutaneous insulin infusion, and a control group of 10 patients who continued to receive conventional treatment--usually two injections of insulin daily. After two years, the experimental group had a significant decrease in glycosylated hemoglobin levels as compared with base-line values (mean +/- S.E.M., 7.6 +/- 0.4 vs 10.2 +/- 0.7 per cent; P less than 0.001), reflecting improved control of blood glucose, and a significant reduction in the width of skeletal-muscle capillary basement membrane (1293 +/- 68 vs. 1717 +/- 182 A; P less than 0.05). The control group of patients had no significant change in their levels of glycosylated hemoglobin or in the width of their skeletal-muscle capillary basement membranes. If changes in the capillaries in skeletal muscle parallel those in the capillaries in retinal or renal tissue, then meticulous control of blood glucose may be beneficial over time in preventing the microvascular complications of diabetes.

Light and electron microscopic findings in poems, or Japanese multisystem syndrome

“…It has been found in diabetics (10)(11)(12)(13). The characteristic thickening of perineurial basement membranes found in diabetics (12) did not occur in our patient; his diabetic state followed the vascular changes and was attributed to the high-dose steroid therapy.…”

The inhibitory effect of lysozyme on the glomerular basement membrane thickening in spontaneous diabetic mice (NSY mice).

“…Although good control on blood glucose can delay the progress of the renal damage, it is unable to ameliorate the lesion. However, Raskin et al (1982) reported that continuous subcutaneous insulin infusion (CSII) reversed the thickening of the glomerular capillary basement membrane. Further studies are needed on this approach to determine its effectiveness in improving renal lesion.…”

Muscle capillary basement membrane width in patients with vacor-induced diabetes mellitus.

“…These investigators observed that in the tightly controlled diabetics, muscle capillary basement membrane width decreased, whereas in the conventionally treated group, muscle capillary basement membrane width at two years was not significantly different from baseline (5). In addition, muscle capillary basement membrane width, after two years oftight control, was similar in the tightly controlled diabetic group and in nondiabetic controls (5). Camerini-Davalos et al examined the effect of glipizide or placebo treatment on muscle capillary basement membrane width in patients with impaired glucose tolerance (6).…”

“…The mechanism by which diabetes results in microangiopathy and muscle capillary basement membrane thickening is unknown, but a number of studies have indicated that alterations in glucose metabolism or other abnormalities that occur in association with poorly controlled diabetes lead to an increase in muscle capillary basement membrane width. Raskin et al longitudinally quantitated muscle capillary basement membrane width in insulindependent diabetics (IDD)' who were either tightly controlled by continuous subcutaneous insulin infusion or treated conven-tionally (5). These investigators observed that in the tightly controlled diabetics, muscle capillary basement membrane width decreased, whereas in the conventionally treated group, muscle capillary basement membrane width at two years was not significantly different from baseline (5).…”

“…Raskin et al longitudinally quantitated muscle capillary basement membrane width in insulindependent diabetics (IDD)' who were either tightly controlled by continuous subcutaneous insulin infusion or treated conven-tionally (5). These investigators observed that in the tightly controlled diabetics, muscle capillary basement membrane width decreased, whereas in the conventionally treated group, muscle capillary basement membrane width at two years was not significantly different from baseline (5). In addition, muscle capillary basement membrane width, after two years oftight control, was similar in the tightly controlled diabetic group and in nondiabetic controls (5).…”