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Beneficial effects of C‐peptide on incipient nephropathy and neuropathy in patients with Type 1 diabetes mellitus
Author(s) -
Johansson B. L.,
Borg K.,
FernqvistForbes E.,
Kernell A.,
Odergren T.,
Wahren J.
Publication year - 2000
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2000.00274.x
Subject(s) - medicine , microalbuminuria , c peptide , endocrinology , placebo , nephropathy , diabetes mellitus , proinsulin , excretion , diabetic nephropathy , insulin , gastroenterology , pathology , alternative medicine
Summary Aims Recent studies have indicated that proinsulin C‐peptide shows specific binding to cell membrane binding sites and may exert biological effects when administered to patients with Type 1 diabetes mellitus. This study was undertaken to determine if combined treatment with C‐peptide and insulin might reduce the level of microalbuminuria in patients with Type 1 diabetes and incipient nephropathy. Methods Twenty‐one normotensive patients with microalbuminuria were studied for 6 months in a double‐blind, randomized, cross‐over design. The patients received s.c. injections of either human C‐peptide (600 nmol/24 h) or placebo plus their regular insulin regimen for 3 months. Results Glycaemic control improved slightly during the study and to a similar extent in both treatment groups. Blood pressure was unaltered throughout the study. During the C‐peptide treatment period, urinary albumin excretion decreased progressively on average from 58 μg/min (basal) to 34 μg/min (3 months, P < 0.01) and it tended to increase, but not significantly so, during the placebo period. The difference between the two treatment periods was statistically significant ( P < 0.01). In the 12 patients with signs of autonomic neuropathy prior to the study, respiratory heart rate variability increased by 21 ± 9% ( P < 0.05) during treatment with C‐peptide but was unaltered during placebo. Thermal thresholds were significantly improved during C‐peptide treatment in comparison to placebo ( n = 6, P < 0.05). Conclusion These results indicate that combined treatment with C‐peptide and insulin for 3 months may improve renal function by diminishing urinary albumin excretion and ameliorate autonomic and sensory nerve dysfunction in patients with Type 1 diabetes mellitus.