24-hour ambulatory blood pressure and renal disease in young subjects with type I diabetes.

Twenty-four hour ambulatory blood pressure (ABP) was evaluated in 150 teenage and young adults with insulin-dependent diabetes mellitus (IDDM) to define high-risk subjects who are likely to develop early diabetic nephropathy. Their age range was 16-28 years with diabetes of 3.5-25.8 years duration. All subjects had office blood pressure (BP) measured, wore an ABP monitor for 24 h, and collected two or more timed urine samples for albumin excretion rates (AERs). Eighty-six subjects had no elevation of AER (< 7.6 micrograms/min), 29 subjects had borderline elevations (7.6-20 micrograms/min), 24 subjects had microalbuminuria (20.1-200 micrograms/min), and 11 had macroalbuminuria (> 200 micrograms/min). Age, gender, duration of diabetes, and single office BP readings were similar in the four groups (p > 0.05, logistic regression). All 24-h ABP parameters were significantly higher in subjects with diabetes having AER values greater than 7.6 micrograms/min when compared with healthy age- and gender-matched nondiabetic controls (p < 0.05, Dunnett's t test). The percent of nighttime systolic and diastolic ABP readings above the 90th percentile of normal for age, gender, and race and the percent of readings in the hypertensive range (> 140/90) were significantly related with AERs (p < 0.01; logistic regression). A higher percentage of ABP values above the 90th percentile for age, gender, and ethnic group or of ABP readings above hypertensive levels (> or = 140/90) are associated with diabetic renal disease.

24-h ambulatory blood pressure monitoring in healthy young adult Anglo, Hispanic, and African-American subjects.

The purpose of this study was to compare office and 24-h ambulatory blood pressure (ABP) values for adolescent and young adult males and females of Anglo, Hispanic, and African-American descent. One hundred and eighteen healthy subjects (62 females, 56 males) participated, with an ethnic distribution of 50 Anglo, 32 Hispanic, and 36 African-American subjects. All subjects came to the clinic for height, weight, sitting blood pressure (BP), and to begin 24-h ABP monitoring using the SpaceLabs model 90207 automatic noninvasive monitor. The monitor recorded readings every 0.5 h from 06:00 to 22:00 and every hour at night from 22:00 to 06:00. Office systolic and diastolic BP values were higher for all males compared to all females. Mean 24-h, nighttime, and daytime systolic ABP values were also significantly higher for males compared to females. The 24-h mean and daytime systolic ABP values were significantly different by ethnic groups. The African-American subjects always had the highest readings. Mean 24-h diastolic ABP was also significantly different by ethnic groups, with the African-American subjects being higher than the Anglos or the Hispanics. Diastolic ABP (24-h mean, daytime, and nighttime) values (for all subjects combined) increased gradually and varied significantly with age. This study provides preliminary normative data about ABP in an understudied population (ie, teenagers and young adults of different ethnic backgrounds). It also shows that higher blood pressures are present among males and among subjects of African-American descent in the teenage and young adult population.

Pre-meal insulin analogue insulin lispro vs Humulin R insulin treatment in young subjects with type 1 diabetes.

The present prospective one-year randomized study was conducted to compare soluble human insulin, with a new rapid-acting human insulin analogue, lispro, with respect to postprandial glucose excursions, frequency of hypoglycaemic episodes, glucose control, and long-term safety in 39 subjects (20 females, 19 males) with Type 1 diabetes. The duration of diabetes, gender distribution, and age were similar in the two groups. The total number of hypoglycaemic episodes was significantly less (p < 0.04, Wilcoxon rank sum test) in subjects receiving insulin lispro compared with regular human insulin over the 12-month period. The 2-h postprandial glucose excursion at 1 year was also significantly less (p < 0.05, ANOVA) in the group treated with insulin lispro. The reductions in the total number of hypoglycaemic episodes and in the postprandial glucose excursion with use of insulin lispro may be beneficial for the long-term management of subjects with Type 1 diabetes. However, the greatest benefit identified by the subjects receiving insulin lispro was the greater convenience of the rapid-acting analogue.