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Biomedical subjects

C E Mogensen

Publications and source records attributed to C E Mogensen.

At least 73 records · Page 4Linked to original sources
PubMed1997

24-h blood pressure and autonomic function is related to albumin excretion within the normoalbuminuric range in IDDM patients.

Significant changes in both blood pressure, autonomic function and kidney ultrastructure are observed in insulin-dependent diabetic (IDDM) patients with microalbuminuria. Intervention strategies are evaluated at even earlier stages of disease. Identification of patients at risk of developing microalbuminuria must be based on a thorough knowledge of the relations between key pathophysiological parameters in patients with normoalbuminuria. The aim of the present study was to characterize the interactions of urinary albumin excretion (UAE), 24-h ambulatory blood pressure (AMBP), and sympathovagal balance in a large group of normoalbuminuric IDDM patients. In 117 normoalbuminuric (UAE < 20 micrograms/min) patients we performed 24-h AMBP (Spacelabs 90207), with assessment of diurnal blood pressure and heart rate (HR) variation, and short-term (three times 5 min) power spectral analysis of RR interval oscillations, as well as cardiovascular reflex tests (HR variation to deep breathing, postural HR and blood pressure response). Patients with UAE above the median (4.2 micrograms/min) had significantly higher 24-h systolic and diastolic AMBP (125 +/- 10.1/76 +/- 7.2 mmHg) compared to the low normolbuminuric group (120 +/- 8.4/74 +/- 5.1 mmHg), p < 0.01 and 0.02, respectively. Patients with UAE above the median had significantly reduced short-term RR interval variability including both the high frequency component (5.47 +/- 1.36 vs 6.10 +/- 1.43 ln ms2), and low frequency component (5.48 +/- 1.18 ln ms2 compared to 5.80 +/- 1.41 ln ms2), p < 0.02 and p = 0.04 (ANOVA). In addition, patients with high-normal UAE had reduced mean RR level (faster heart rates) 916 +/- 108 compared to 963 +/- 140 ms, p < 0.04. These differences were not explained by age, duration of diabetes, gender, level of physical activity, or cigarette smoking. HbA1c was significantly higher (8.6 +/- 1.2 vs 8.2 +/- 1.0%, p = 0.03) in the group with high normal UAE. Comparing normoalbuminuric IDDM patients with UAE above and below the median value, we found significantly higher AMBP in combination with significant differences in sympathovagal balance and significantly poorer glycaemic control in the group with high-normal albumin excretion. Our data demonstrate interactions between albumin excretion, blood pressure, autonomic function, and glycaemic status, already present in the normoalbuminuric range and may describe a syndrome indicative of later complications.

Adult↗
PubMed1997

Comparison of the combination of enalapril and a very low dose of hydrochlorothiazide with atenolol in patients with mild-to-moderate hypertension. Scandinavian Study Group.

The blood pressure lowering effect and tolerability of the angiotensin-converting enzyme inhibitor enalapril combined with a very low dose of hydrochlorothiazide (HCTZ) were compared with the selective betareceptor blocker atenolol in patients with mild-to-moderate hypertension. Three hundred seventy-four patients were randomized into a triple-blind, parallel, active-controlled 12-week study period comparing enalapril/HCTZ (20/6 mg) with atenolol (50 mg) after a 4-week placebo baseline period. Blood pressure (BP), clinical and laboratory safety, and metabolic laboratory variables were assessed. Enalapril/HCTZ as well as atenolol reduced both sitting and standing diastolic and systolic BP (P < .001), but enalapril/HCTZ had a more pronounced effect than atenolol on sitting systolic BP (P = .019); there was a trend toward more patients achieving target diastolic BP (<90 mm Hg, P = .053). No clinically important differences in safety and tolerability were observed.

Adolescent↗
PubMed1997

The clinical course of renal function in NIDDM patients with normo- and microalbuminuria.

OBJECTIVES: To assess the clinical course of renal function in relation to risk factors in NIDDM patients with normo- and microalbuminuria. DESIGN: Prospective clinical study. SETTING: Outpatient diabetic clinic. SUBJECTS: Thirty-two NIDDM patients with normo- or microalbuminuria followed for (mean (range)) 5.5 (3.3-7.5) years. MAIN OUTCOME MEASURES: Glomerular filtration rate, urinary albumin excretion rate, blood pressure, lipids, glycaemic control. RESULTS: The mean rate of decline of glomerular filtration rate was -1.2 +/- 2.3 (mean +/- SD) (95% confidence intervals: -2.0--0.3) mL min-1 1.73 m-2 year-1 (p = 0.009). A considerable interindividual variation was observed (range -6.7 to + 3.4 mL min-1 1.73 m-2 year-1). No difference was found between normo- and microalbuminuric patients (-1.2 +/- 0.5 vs. -1.0 +/- 0.7 mL min-1 1.73 m-2 year-1) or between patients with and without anti-hypertensive treatment (-1.7 +/- 0.7 vs. -0.7 +/- 0.4 mL min-1 1.73 m-2 year-1). By multiple linear regression analysis the fall rate of glomerular filtration was determined by the mean glomerular filtration rate level (p = 0.036). Analysis of patients without antihypertensive treatment revealed that urinary albumin excretion rate and HbA1c levels significantly determined the fall rate of glomerular filtration (P < 0.001 and = 0.014). CONCLUSIONS: The average decline in renal function of these normo- and microalbuminuric NIDDM patients was not increased as compared to the age related fall rate of healthy subjects but varied markedly. Low glomerular filtration rate is associated with a higher fall rate. In patients without antihypertensive treatment higher urinary albumin excretion rate, and poorer glycaemic control are factors associated with an increased fall rate of glomerular filtration.

Aged↗
PubMed1997

How to protect the kidney in diabetic patients: with special reference to IDDM.

During the development to overt nephropathy, diabetic patients go through several characteristic stages of renal disease, moving from normo- to micro- to macroalbuminuria. Microalbuminuria is defined as a urinary albumin excretion between 20 and 200 microg/min; values <20 microg/min are designated as normoalbuminuria, and values >200 microg/min are designated as macroalbuminuria. Only with macroalbuminuria does the glomerular filtration rate (GFR) fall consistently. The decisive intermediary endpoints are postponement or prevention of micro/macroalbuminuria and reduction or prevention of the fall in GFR (stronger endpoint), with postponement of end-stage renal disease as a final endpoint. Good metabolic control can prevent or postpone the development of microalbuminuria, the earliest sign of diabetic renal disease. The ideal realistic therapeutic window may be an HbA1c value between 7 and 8.5% (mean reference value 5.5%). Thus, efforts should aimed at implementing the best possible control before the onset of microalbuminuria, with the other important aim of minimizing hypoglycemic side effects. In patients with microalbuminuria, blood pressure gradually increases, and early antihypertensive treatment becomes crucial. Good glycemic control (with the same glycemic goal as above) may be difficult to achieve in some of these patients, but it is still important. With overt nephropathy, defined as clinical proteinuria, a relentless decline in GFR is inflicted, unless patients are carefully treated with antihypertensive agents, often in combination therapy. Good metabolic control is still strongly warranted because patients with high HbA1c progress much more rapidly. The natural history of the rate of fall in GFR may be reduced from 12 to 3 ml x min(-1) x year(-1), but genetic factors may be involved; the ACE-genotype DD seems to progress more rapidly during treatment. Protein restriction is also of some interest. Early screening is recommended in all guidelines, with emphasis on testing for albuminuria, including microalbuminuria, along with careful control of glycemia and blood pressure.

Adult↗
PubMed1997

Multicenter evaluation of the Micral-Test II test strip, an immunologic rapid test for the detection of microalbuminuria.

OBJECTIVE: To assess the performance of the Micral-Test II immunologic test strip for the detection of microalbuminuria, a multicenter evaluation in eight European study sites was performed. RESEARCH DESIGN AND METHODS: Using both the Micral-Test II test strip and the routine method for the determination of albumin concentration, we investigated 2,228 urine samples from diabetic patients. Additionally, interperson variability, color stability, and possible interfering factors (temperature, pH, leucocyturia, erythrocyturia, and drugs) were tested. RESULTS: For a cutoff concentration of 20 mg/l with respect to the routine methods, a sensitivity of 96.7% and a specificity of 71% were calculated for the Micral-Test II test strip. The negative predictive value was 0.95, and the positive predictive value was 0.78, with a prevalence of positive samples (laboratory method) of 52%. The interperson variability of color interpretation showed 93% concordant readings. The interference study showed an influence of oxytetracycline, leading to higher readings. There was no interference from pH. A sample temperature of < 10 degrees C led to lower readings. In the case of samples with massive leucocyturia and erythrocyturia that may delete the chromatographic process, waiting an additional 1-2 min is needed before reading. CONCLUSIONS: The results of the multicenter evaluation show that the Micral-Test II test strip permits an immediate and reliable semiquantitative determination of low albumin concentrations in urine samples with an almost user-independent color interpretation.

Albuminuria↗
PubMed1997

Elevated ambulatory blood pressure in microalbuminuric IDDM patients is inversely associated with renal plasma flow. A compensatory mechanism?

OBJECTIVE: To evaluate the relationship between renal function, ambulatory blood pressure (AMBP), and glycemic control in microalbuminuric IDDM patients compared with normoalbuminuric patients. RESEARCH DESIGN AND METHODS: Nineteen male patients (age 33 +/- 6 years) with slight microalbuminuria (UAE 20-70 micrograms/min) were compared with 19 normoalbuminuric (UAE < 15 micrograms/min) age-matched (33 +/- 6 years) male patients. Through constant infusion technique, 125I-iothalamate marked the glomerular filtration rate (GFR), and 131I-hippuran marked effective renal plasma flow (RPF). AMBP was measured by oscillometric technique (Spacelabs 90202). RESULTS: The microalbuminuric group had higher daytime systolic AMBP (132 +/- 11 vs. 125 +/- 7 mmHg, P < 0.05) and a poorer glycemic control (HbA1c 9.5 +/- 1.5 vs. 8.2 +/- 1.3%, P < 0.01). GFR (135 +/- 22 and 135 +/- 17 ml/min) and RPF (598 +/- 112 and 542 +/- 98 ml/min) were similar in the two groups. In the microalbuminuric group, daytime systolic AMBP was inversely correlated to both RPF (r = -0.77, P < 0.005) and GFR (r = -0.53, P = 0.02). HbA1c and GFR correlated positively in the microalbuminuric group (r = 0.47, P < 0.04). In contrast, the normoalbuminuric patients exhibited no such associations. CONCLUSIONS: IDDM patients with moderate microalbuminuria have elevated AMBP and a strong negative association between AMBP and RPF. This leaves several possibilities of interpretation. Primary blood pressure increase (of unknown origin) may induce morphological changes leading to reduction in renal function. Alternatively, blood pressure increase early in the course of incipient nephropathy may represent a compensatory mechanism, initially aiming at preservation of renal function, but later becoming maladaptive.

Adult↗
PubMed1997

Losartan reduces albuminuria in patients with essential hypertension. An enalapril controlled 3 months study.

BACKGROUND: Elevated urinary albumin excretion is a common feature of essential hypertension which may be reduced by ACE-inhibition through independent reductions of both systemic and intraglomerular pressure. A concurrent inhibition of bradykinin breakdown may be involved. METHODS: A double-blind, randomized, 12 weeks study of the effects on enalapril 20 mg (n = 46) vs losartan 50 mg daily (n = 47) on blood pressure, albuminuria, fasting blood glucose, and lipids in 57 male and 36 female patients with essential hypertension. RESULTS: Blood pressure was similarly reduced during both treatments: enalapril 156/102 (15/5) (mean [SD] to 142/92 [14/7]) mmHg, losartan: 159/103 (17/6) to 149/94 (21/9) mmHg, both P < 0.001. Urinary albumin to creatinine ratio was significantly reduced during losartan (from 1.14(x/divided by 2.48) (geometric mean (x/divided by antilog SD) to 0.81 (x/divided by 2.43) mg/mmol, P < 0.01), as well as during enalapril (from 0.95 (x/divided by 2.45) to 0.73 (x/divided by 2.00) mg/mmol, both P < 0.05). The effect on albuminuria was especially evident in patients with microalbuminuria. Fasting blood glucose, total cholesterol, HDL-cholesterol and triglycerides were unchanged during losartan, whereas minor reductions were found in all lipids during enalapril. No difference was observed between the groups. CONCLUSION: Enalapril 20 mg and losartan 50 mg daily reduce blood pressure equally in essential hypertensive patients. No adverse effects were seen on glucose and lipid concentrations. Losartan treatment reduces albuminuria at least as effectively as enalapril, suggesting that glomerular leakage of albumin is profoundly affected by the effects angiotensin II.

Adult↗
PubMed1997

The relationship between microalbuminuria in first generation diabetic and non-diabetic subjects and microalbuminuria and hypertension in the second generation (a population based study).

BACKGROUND: Predisposition to hypertension has been proposed as a risk factor for development of diabetic nephropathy and hypertension. The aim of this study was to examine a possible relation between microalbuminuria (urinary albumin excretion (UAE) 20-200 micrograms/min) in diabetic and non-diabetic subjects and microalbuminuria as well as hypertension in the next generation. METHODS: We examined 280 non-diabetic subjects in a cross sectional study (mean age 47-48 years). 136 were first born offspring of non insulin dependent diabetic (NIDDM) patients and 144 were first born offspring of non-diabetic controls. Hypertension was defined as systolic blood pressure > 140 mmHg, and/or diastolic blood pressure > 90 mmHg, and/or the presence of antihypertensive medications. Data were analysed by multiple logistic regression. RESULTS: We found that parental microalbuminuria was not predictive for microalbuminuria in the second generation in this population at the time of follow-up. However, microalbuminuria was predictive for hypertension in the second generation of diabetic patients, Odds ratio (OR) = 2.5, P = 0.05 when adjusted for age, gender, smoking, and obesity. In offspring of non-diabetic persons parental microalbuminuria also increased the risk of hypertension in the offspring generation, OR = 3.7, P = 0.02. Obesity was the strongest predictor for microalbuminuria and for hypertension in offspring of diabetic patient and of non-diabetic persons. CONCLUSION: We found a significant relation between microalbuminuria in the parental generation and hypertension in the offspring both of a diabetic population and of a non-diabetic population.

Albuminuria↗
PubMed1997

High normo- or low microalbuminuria: basis for intervention in insulin-dependent diabetes mellitus.

Recent studies have further elucidated the association between blood pressure and albumin excretion in insulin-dependent diabetes mellitus (IDDM) patients with (i) normal urinary albumin excretion (UAE), and (ii) moderate microalbuminuria (20 to 70 micrograms/min). In a study comprising 117 normoalbuminuric (UAE < 20 micrograms/min) patients we performed 24-hour ambulatory blood pressure monitoring (AMBP), and short-term power spectral analysis of RR interval oscillations. In comparison with the group with a UAE below the median, patients with UAE above the median were characterized by: significantly higher 24-hour systolic and diastolic AMBP, significantly reduced short-term RR interval variability, and significantly higher HbA1c. In a double blind study, normotensive IDDM patients with moderate microalbuminuria (20 to 70 micrograms/min) were randomized to either lisinopril (20 mg once a day, N = 12) or placebo (N = 10) for two years. In the lisinopril group there were significant reductions in 24-hour systolic and diastolic AMBP compared to the placebo group. Lisinopril did not attenuate the diurnal blood pressure variation. UAE tended to be reduced in the lisinopril group. A significantly positive association between changes in AMBP and changes in UAE was present in the placebo group in contrast to the lisinopril group. Changes in UAE were strongly and positively associated with changes in filtration fraction in the lisinopril treated group. In conclusion, interactions between albumin excretion, blood pressure, autonomic function, and glycemic status are already detectable within the normoalbuminuric range in IDDM patients. Angiotensin converting enzyme inhibitor (ACEi) treatment in a small group of normotensive IDDM patients with moderate microalbuminuria reduces blood pressure without attenuating diurnal blood pressure variation, tends to reduce albumin excretion, and abolishes the association between changes in UAE and changes in blood pressure observed in the placebo group. ACEi intervention in selected normoalbuminuric high risk patients (high-normal UAE, high-normal blood pressure, and poor glycemic control) would be of interest.

Albuminuria↗
PubMed1996

Birth weight and cardiovascular risk factors in an epidemiological study.

Low birth weight has been proposed as a risk factor for development of non-insulin-dependent diabetes mellitus, hypertension, and cardiovascular disease in the adult. To ascertain the extent to which birth weight was associated with cardiovascular risk factors, we examined 620 subjects (median age 48 years) in a cross-sectional study. Of these 317 were offspring of diabetic patients and 303 were offspring of non-diabetic control subjects. Known risk factors for development of cardiovascular disease were correlated to birth weight and examined as dependent variables by multiple linear regression. Age, body mass index (BMI), subjects gender along with parental gender, diabetes status of the parents, and birth weight were independent variables. The variance of the risk factors as dependent variables explained by age, gender, and BMI as independent variables was examined and birth weight was added as an independent variable. We found birth weight was inconsistently correlated to the different risk factors in the different groups of subjects. When adjusted for age, BMI, subject's gender, parental gender, and the diabetes status of the parents, birth weight was negatively correlated to fasting blood glucose. In offspring of diabetic patients the explained variance of risk factors did not change as we added birth weight to the model. In offspring of non-diabetic subjects we found that the explained variance of diastolic blood pressure, fasting blood glucose, HbA1c, and cholesterol increased 1-3% as birth weight was added to the model. We conclude that birth weight may not be a major risk factor for development of hypertension and cardiovascular disease in our population.

Adult↗
PubMed1996

Low birth weight--is it associated with few and small glomeruli in normal subjects and NIDDM patients?

UNLABELLED: These studies were undertaken to ascertain if there is any association between low birth weight, and low kidney weight, few and/or small glomeruli, in kidneys from a control group and a group of non-insulin-dependent diabetic (NIDDM) patients. The background for this study comes from findings suggesting a correlation between low birth weight and the development of NIDDM and high blood pressure. Furthermore, Brenner has postulated that humans born with a low number of glomeruli, thereby having a low glomerular filtration surface area, have a greater tendency to develop high blood pressure. We examined 79 autopsy kidneys, with known weight from normal and NIDDM patients, which had previously been used for studies of glomerular number and volume. In the archives of the Danish midwives we were able to find birth weight for 26 NIDDM patients and an age- and sex-matched sample of 19 control persons. The kidney weight (g) ( CONTROL: 137 +/- 36; NIDDM: 150 +/- 38; 2p = 0.26), glomerular number (10(3)) (CONTROL: 670 +/- 176; NIDDM: 673 +/- 200; 2p = 0.95), glomerular volume (10(6) micron3) (CONTROL: 6.25 +/- 1.48; NIDDM: 5.71 +/- 1.74; 2p = 0.28) or birth weight (g) ( CONTROL: 3577 +/- 400; NIDDM: 3489 +/- 429; 2p = 0.49) were not different between the groups. There was no significant correlation between birth weight and glomerular number ( CONTROL: 2p = 0.80; r = 0.06 and NIDDM: 2p = 0.10; r = -0.33), glomerular volume ( CONTROL: 2p = 0.43; r = 0.19 and NIDDM: 2p = 0.78; r = 0.06) or kidney weight ( CONTROL: 2p = 0.56; r = 0.14 and NIDDM: 2p = 0.81; r = 0.05). Our results on a limited number of subjects in Denmark do not support the hypothesis that there is any association between low birth weight and low kidney weight or low birth weight and few and/or small glomeruli in NIDDM patients.

Adult↗
PubMed1996

How often is NIDDM complicated with non-diabetic renal disease? An analysis of renal biopsies and the literature.

According to extensive autopsy studies, non-diabetic renal disease seems to be rare in diabetes mellitus, but recent publications suggest a significant prevalence of non-diabetic renal disease in non-insulin-dependent diabetic (NIDDM) patients, especially in the absence of retinopathy. The purpose of this study was to evaluate the prevalence of non-diabetic renal disease in NIDDM patients in renal biopsies from clinical practice, in patients suspected of having non-diabetic renal disease. In addition we systematically reviewed the literature. Biopsies were evaluated at the University Department of Pathology, Aarhus, Denmark, but had been collected at several departments of nephrology. In total 33 consecutive biopsies were available from 1988-1995 (mean age of patients: 62 years (range 39-75) (mean known diabetes duration 8 years (range 1-25); the main clinical reason for a biopsy was proteinuria. Renal function changes ranged from slight elevation of serum creatinine to uraemia. In addition 9 original papers, including our own material 580 patients were examined. On the basis of careful morphological evaluation according to international criteria, no patient exhibited an unequivocal sign of non-diabetic glomerular disease. Two patients had strongly but not completely convincing evidence of glomerulonephritis. One patient had some evidence of glomerulonephritis. These 3 patients also exhibited diabetic lesions. One patient with end-stage renal disease showed evidence of interstitial nephropathy without glomerular lesions. Thus, in 4 patients evidence of non-diabetic lesions was found. In the remaining 29 patients typical diffuse (n = 9) or nodular (n = 20) diabetic lesions were found. Twenty patients showed evidence of diabetic retinopathy. One of the patients with evidence of non-diabetic renal disease had simplex retinopathy. In the literature a considerable bias exists towards including patients with non-diabetic renal disease. In non-biased materials with proteinuria the prevalence of non-diabetic renal disease is very similar to our series. In microalbuminuric patients non-diabetic renal disease seems to be very rare. It can be concluded that in our material non-diabetic renal disease is uncommon in NIDDM patients, even if a clinician has suggested renal disease of other origin. A considerable bias towards including non-diabetic renal disease in NIDDM patients exists in the literature. The indication for biopsy should be evaluated carefully, and biopsy should by no means be routinely performed in NIDDM patients with proteinuria.

Adult↗
PubMed1996

Clinical features in persons with a family history of diabetes compared to controls (The Second Generation Fredericia Study).

OBJECTIVE: To compare clinical and biochemical features in non-diabetic persons with a family history of non-insulin dependent diabetes mellitus (NIDDM) to non-diabetic persons without a family history of diabetes. DESIGN: Cross-sectional study. SETTING: Population-based survey in Fredericia, Denmark. SUBJECTS: Seven hundred and forty subjects, the second generation of an earlier defined cohort was examined. The median age was 48 (range 26-65) years. Of the 740 subjects 696 were non-diabetic. INTERVENTIONS: The subjects had a clinical examination. MAIN OUTCOME MEASURES: Known risk factors for development of diabetes and cardiovascular disease. RESULTS: More offspring of diabetic persons had NIDDM (chi 2 = 6.36, P < 0.05). Non-diabetic males with a family history of diabetes had a higher BMI fasting blood glucose, and triglycerides compared to males without a family history of diabetes. Non-diabetic females with a family history of diabetes had a higher BMI, fasting blood glucose. HbA1C, diastolic blood pressure, and lower HDL-cholesterol than female offspring of non-diabetics. In a multiple regression model we found that non-diabetic off-spring of diabetic persons had higher fasting blood glucose and HbA1C compared to offspring of non-diabetic persons when adjusted for the independent variables age, BMI, WHR, and sex. CONCLUSION: Our results may indicate that the only inherited factors from NIDDM patients are plasma blood glucose. HbA1C and increased BMI which may be an indication for later diabetes, whereas other cardiovascular risk factors may be inherited independently of diabetes but associated with BMI.

Adult↗
PubMed1996

Isokinetic muscle strength in long-term IDDM patients in relation to diabetic complications.

The isokinetic muscle strength in 56 IDDM patients with > 20 years of diabetes duration and in their individually sex-, age-, weight-, and height-matched control subjects was assessed. Peak torque of foot dorsal and plantar flexion and knee and wrist extension and flexion was measured. The neuropathic condition was assessed by a neurological disability score, a neuropathy symptom score, nerve conduction studies, and quantitative sensory examination. All results were summed to obtain a neuropathy rank-sum score for each patient. According to their renal albumin excretion, the patients were classified to have normo-, micro-, or macroalbuminuria. In addition, according to their retinal status, patients were classified as having no, simple, or proliferative retinopathy. The IDDM patients had a 21% reduction of muscle strength of both ankle dorsal (P < 1 x 10(-4)) and plantar flexors (P < 0.01), compared with control subjects. A 16% reduction of knee extensors (P < 0.005) and a 17% reduction of knee flexors (P < 0.01) was found. In contrast, muscle strength in wrist flexors and extensors was not significantly reduced (10 and 11%, respectively [NS]). In patients with the most severe weakness, muscle strength of the calf muscles was only 50% of the expected performance. Correlations were found between the neuropathy rank-sum score and the muscle strength of ankle dorsal (r = -0.66, P < 1 x 10(-7)) and plantar flexors (r = -0.51, P < 0.0005), knee extensors (r = -0.51, P < 0.0005) and flexors (r = -0.44, P < 0.005), and wrist flexors (r = -0.41, P < 0.005). No correlation was found for wrist extensors (r = 0). Neither were there any relationships between muscle strength at the ankle and knee and the degree of albuminuria or retinopathy. In conclusion, motor performance is substantially impaired in long-term IDDM patients, and the weakness is related to the presence of neuropathy but not to albuminuria or retinopathy per se.

Adult↗