Comparison of blood pressure level in patients with insulin-dependent diabetes mellitus (type I) after 3,5 years of intensive or conventional insulinotherapy

Abstract

Background The aim of the study was to assess possible differences in blood pressure (BP) and heart rate (HR) between intensively treated (4-5 insulin injections/day) and conventionally treated (2 insulin injections/day) patients with short-lasting insulin dependent diabetes mellitus (IDDM).
Methods Twenty-one patients with incipient IDDM were intensively treated from the very onset of the disease. Twenty-one conventionally treated IDDM patients served as a reference group. Mean age of intensively and conventionally treated patients (23.4 ± 3.9 vs 24.5 ± 7.2 years), as well as duration of diabetes, body mass index (BMI), and daily insulin dose did not differ significantly. After average 3.5-year follow-up period, BP and HR were assessed during routine check-up in diabetic out-patient clinic (office BP), duńng 24-h ambulatory monitoring as well as in standardized laboratory conditions following 15-min adaptation periods to supine and upright positions.
Results Metabolic control was significantly better in intensively treated than in conventionally treated IDDM patients (HbAlc 6.6 ± 1.0 vs 9.2 ± 2.4%, Student's t-test, p < 0.0001). There were no significant differences between the groups both 1'or office BP and HR. There were virtually no significant differences between intensively and conventionally treated patients in HR and BP during 24-h ambulatory monitońng as for 24-hours, daytime-, night-time-, and 1-hour-means, as well as night/day ratios. No significant differences in BP following 15-min adaptation peńods to supine and upńght positions were observed between the groups. However, mean HR after 15-min supine rest was significantly lower in intensively treated patients when compared with conventionally treated diabetics (65.9 ± 8.2 vs 74.4 ± 13.3 beats/min, Student's t-test, p<0.02). There were no significant differences in HR between the groups after 15-min adaptation to upńght position.
Conclusions In spite of significant differences in metabolic control, no significant differences in BP profile between intensively and conventionally treated patients with short-lasting (mean 3.5-year) IDDM have been revealed. Higher HR in conventionally treated diabetics may suggest earlier onset of autonomic neuropathy in this group of patients.