Near-normotension and near-normoglycemia in blind Type I diabetic patients with overt diabetic nephropathy

In patients with diabetic nephropathy, near-normalization of blood pressure (BP) and blood sugar may have a beneficial impact on changes in kidney function, but visually impaired patients may face difficulties when striving for optimal control of hypertension and hyperglycemia. In a prospective feasibility study, we followed a group of nine blind Type I (insulin-dependent) diabetic patients (mean age 30 ± 4 years) with overt diabetic nephropathy and uncontrolled hypertension. All patients received intensified insulin therapy after a structured diabetes treatment and teaching program, and adapted their antihypertensive drug treatment to self-monitored BP values. At recruitment, HbA_1c values were 5.8 ± 0.6%, and remained stable at 6.3 ± 1.7% after a mean observation period of 27 months. BP pressure decreased from $\text{150 ±}\text{14}\text{99}\text{± 14}\text{mmHg to 130 ±}\text{17}\text{86}\text{± 10 mmHg}$ after 1 year, and to $\text{140 ±}\text{14}\text{99}\text{± 9}\text{mmHg}$ at the last examination, (p < 0.05). Serum creatinine and creatinine clearance remained stable over the observation period at 165 ± 56 μmol/L and 0.8 ± 0.4 ml/s/1.72m² at recruitment, and 152 ± 47 μmol/L and 1.0 ± 0.5 ml/s/1.72m² at the final examination. Proteinuria decreased from 3.2 to 1.4 g/24 h (p < 0.05). No patient needed renal replacement therapy. In a reference group of hypertensive Type I diabetic patients with overt nephropathy who did not have the opportunity to participate in the hypertension treatment and teaching program, BP increased despite antihypertensive therapy from $\text{143 ±}\text{19}\text{87}\text{± 10}\text{mmHg}$ to $\text{160 ±}\text{28}\text{95}\text{± 13}\text{mmHg}$ (NS) while serum creatinine increased from 165 ± 32 to 410 ± 285 μmol/L (p < 0.01). Four patients needed renal replacement therapy. These results indicate that after appropriate training, blind Type I diabetic patients with overt nephropathy may be able to achieve and maintain long-term normotension, and near-normal glycosylated hemoglobin values, which may have beneficial effects on renal function.