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  • 1
    Electronic Resource
    Electronic Resource
    Pre-diabetic blood pressure predicts urinary albumin excretion after the onset of Type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians (1993)
    Springer
    Diabetologia 36 (1993), S. 998-1001 
    Details
    ISSN: 1432-0428
    Keywords: Albuminuria ; risk factors ; blood pressure ; Type 2 (non-insulin-dependent) diabetes mellitus ; Pima Indians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Blood pressure was measured in 490 non-proteinuric Pima Indians from the Gila River Indian Community in Arizona at least 1 year before the diagnosis of Type 2 (non-insulin-dependent) diabetes mellitus. Urine albumin concentration was measured in the same subjects 0–24 years (mean 5 years) after diabetes was diagnosed. Prevalence rates of abnormal albumin excretion (albumin-to-creatinine ratio ≥100 mg/g) after the onset of Type 2 diabetes were 9%, 16%, and 23%, respectively, for the lowest to highest tertiles of pre-diabetic mean blood pressure. When controlled for age, sex, duration of diabetes and pre-diabetic 2-h post-load plasma glucose concentration, higher pre-diabetic mean blood pressure predicted abnormal urinary excretion of albumin after the onset of diabetes. This finding suggests that the higher blood pressure seen in diabetic nephropathy is not entirely a result of the renal disease, but may precede and contribute to it.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02374490
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  • 2
    Electronic Resource
    Electronic Resource
    Determinants of end-stage renal disease in Pima Indians with Type 2 (non-insulin-dependent) diabetes mellitus and proteinuria (1993)
    Springer
    Diabetologia 36 (1993), S. 1087-1093 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic nephropathy ; proteinuria ; end-stage renal disease ; Type 2 (non-insulin-dependent) diabetes mellitus ; blood pressure ; Pima Indians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To identify factors related to the development of end-stage renal disease after the onset of proteinuria, its incidence was determined in 364 Pima Indians aged 35 years or older with Type 2 (non-insulin-dependent) diabetes mellitus and proteinuria (protein-to-creatinine ratio ≥0.5 g/g). Of these 364 subjects, 95 (36 men, 59 women) developed end-stage renal disease. The cumulative incidence was 40% 10 years after and 61% 15 years after the onset of proteinuria. The incidence of end-stage renal disease was significantly related to the duration of diabetes, the duration of proteinuria, higher 2-h plasma glucose concentration, type of diabetes treatment, and the presence of retinopathy at the time of recognition of the proteinuria, but not to age, sex, or blood pressure. Duration of proteinuria influenced the risk of end-stage renal disease, contingent, however, upon the duration of diabetes at the onset of proteinuria. The higher cumulative incidence of end-stage renal disease 15 years after the onset of proteinuria in Pima Indians (61 %) than in Caucasians from Rochester, Minnesota (17%) may be attributable, in part, to the younger age of onset of Type 2 diabetes in Pima Indians than in Caucasians, to ethnic differences in susceptibility to renal disease, or to lower death rates among the Pima Indians from competing causes of death, such as coronary heart disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02374503
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  • 3
    Electronic Resource
    Electronic Resource
    The association of physical activity with obesity, fat distribution and glucose intolerance in Pima Indians (1993)
    Springer
    Diabetologia 36 (1993), S. 863-869 
    Details
    ISSN: 1432-0428
    Keywords: Physical activity ; obesity ; fat distribution ; glucose intolerance ; Pima Indians ; exercise
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The relationships between physical activity, obesity, fat distribution and glucose tolerance were examined in the Pima Indians who have the highest documented incidence of non-insulin-dependent diabetes. Fasting and 2-h post-load plasma glucose concentrations, body mass index, and waist-to-thigh circumference ratios were determined in 1054 subjects aged 15–59 years. Current (during the most recent calendar year) and historical (over a lifetime) leisure and occupational physical activity were determined by questionnaire. Current physical activity was inversely correlated with fasting and 2-h plasma glucose concentrations, body mass index and waist-to-thigh ratios for most sex-age groups even when diabetic subjects were excluded. Controlled for age, obesity and fat distribution, activity remained significantly associated with 2-h plasma glucose concentrations in males. In subjects aged 37–59 years, individuals with diabetes compared to those without reported significantly less leisure physical activity during the teenage years (median hours per week of activity, 9.1 vs 13.2 for men; 1.0 vs 2.2 for women). Controlled for body mass index, sex, age and waist-to-thigh ratio, subjects who reported low levels of historical leisure physical activity had a higher rate of diabetes than those who were more active. In conclusion, current physical activity was inversely related to glucose intolerance, obesity and central distribution of fat, particularly in males. Subjects with diabetes were currently less active and reported less historical physical activity than non-diabetic subjects. These findings suggest that activity may protect against the development of non-insulin-dependent diabetes both directly and through an influence on obesity and fat distribution.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400363
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  • 4
    Electronic Resource
    Electronic Resource
    Plasma lipoproteins and the incidence of abnormal excretion of albumin in diabetic American Indians: The Strong Heart Study (1998)
    Springer
    Diabetologia 41 (1998), S. 1002-1009 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Lipoproteins ; albuminuria ; nephropathies ; Type II diabetes ; Strong Heart Study.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Animal studies suggest that lipids are risk factors for kidney diseases. Some prospective studies and clinical trials have reported predictive effects of lipoproteins on different stages of diabetic nephropathy in humans. We examined lipoprotein abnormalities to determine if they predict abnormal urinary excretion of albumin ( ≥ 30 mg albumin/g creatinine), using logistic regression. We followed 671 American Indians (211 men, 460 women) with Type II diabetes for a mean of 3.9 years (range 1.7–6.2). Participants were aged 45–74 years. They had normal excretion of albumin and normal serum creatinine at baseline. 67 men and 144 women developed abnormal excretion of albumin. In models controlled for age, treatment with oral hypoglycaemic agents or insulin, HbA1 c, study site, degree of Indian heritage, mean arterial blood pressure, albumin excretion at baseline and duration of diabetes, a high HDL cholesterol was a protector for abnormal excretion of albumin in women [odds ratio (OR) comparing the 90th with the 10th percentile = 0.56, 95 % confidence interval (CI) = 0.32–0.98], but not in men (OR = 1.5, 95 % CI = 0.66–3.4). Further adjustment for obesity, insulin concentration, alcohol consumption or physical activity did not change the results. There was a tendency for high values of VLDL and total triglyceride and small LDL size to predict abnormal excretion of albumin in women only. We conclude that low HDL cholesterol was a risk factor for abnormal excretion of albumin in women, but not in men. Sex hormones may be responsible for sex differences in the association between HDL cholesterol and abnormal excretion of albumin. [Diabetologia (1998) 41: 1002–1009]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051023
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  • 5
    Electronic Resource
    Electronic Resource
    Incidence of end-stage renal disease in Type 2 (non-insulin-dependent) diabetes mellitus in pima indians (1988)
    Springer
    Diabetologia 31 (1988), S. 730-736 
    Details
    ISSN: 1432-0428
    Keywords: End-stage renal disease ; diabetic nephropathy ; Type 2 (non-insulin-dependent) diabetes ; incidence ; Pima Indians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The incidence of end-stage renal disease was determined in the Pima Indians of the Gila River Indian Community in Arizona, a population with a high prevalence of Type 2 (non-insulin-dependent) diabetes mellitus. Between 1975 and 1986, from a study population of 5059 subjects, end-stage renal disease occurred in 80 persons, 76 (95%) of whom had Type 2 diabetes. A review of the cases with end-stage renal disease indicated that among the diabetic subjects only two cases could be attributed to nondiabetic renal disease; all other cases were attributable to diabetic nephropathy. In diabetic Pima Indians the incidence rate of end-stage renal disease did not change during the study period, was similar in men and women, and was not effected by age at diagnosis of diabetes or by attained age, but did increase significantly with hypertension (p〈0.05). The incidence of end-stage renal disease attributed to diabetic nephropathy increased from 0 cases/1000 person-years at 0–5 years to 40.8 cases/1000 person-years at ≥ 20 years duration of diabetes. In these subjects with Type 2 diabetes, the incidence rate of end-stage renal disease was similar to that in subjects with Type 1 (insulin-dependent) diabetes who were followed at the Joslin Clinic in Boston, Massachusetts when those with similar duration of diabetes were compared.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00274774
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  • 6
    Electronic Resource
    Electronic Resource
    Familial predisposition to renal disease in two generations of Pima Indians with Type 2 (non-insulin-dependent) diabetes mellitus (1990)
    Springer
    Diabetologia 33 (1990), S. 438-443 
    Details
    ISSN: 1432-0428
    Keywords: Type 2 (non-insulin-dependent) diabetes mellitus ; American Indians ; diabetic renal disease ; genetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied the occurrence of renal disease by measuring serum creatinine and urine protein concentrations in the diabetic members of 316 Pima Indian families with Type 2 (non-insulin-dependent) diabetes in two successive generations to determine if diabetic renal disease aggregates in families. After adjustment for sex and other risk factors, proteinuria occurred among 14.3% of the diabetic offspring if neither parent had proteinuria, 22.9% if at least one diabetic parent had proteinuria, and 45.9% if both parents had diabetes and proteinuria. Among male offspring, an elevated serum creatinine concentration (≥177 μmol/l) was present in 11.7% if the parent had an elevated creatinine and in 1.5% if the parent did not. Thus, proteinuria and high serum creatinine aggregated in diabetic families, suggesting that susceptibility to renal disease is inherited independently of diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00404096
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  • 7
    Electronic Resource
    Electronic Resource
    Podocyte number predicts long-term urinary albumin excretion in Pima Indians with Type II diabetes and microalbuminuria (1999)
    Springer
    Diabetologia 42 (1999), S. 1341-1344 
    Details
    ISSN: 1432-0428
    Keywords: Key words Type II diabetes mellitus ; diabetic nephropathies ; epithelial cell ; glomerulus ; Indians ; North American.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. The predictive value of glomerular structure on progression of renal disease was examined in patients with Type II (non-insulin-dependent) diabetes and microalbuminuria (urinary albumin-to-creatinine ratio = 30–299 mg/g). Methods. Kidney biopsy specimens were obtained from 16 diabetic Pima Indians (6 men, 10 women). Progression of renal disease was assessed by measuring urinary albumin excretion 4 years after the biopsy (UAE4 years) and by computing the change in urinary albumin excretion during the study (Δ UAE). Results. At baseline, the duration of diabetes averaged 13.3 years (range = 4.0–23.8 years) and the mean glomerular filtration rate was 159 ml · min–1· 1.73m–2 (range = 98 – 239 ml · min–1· 1.73m–2). Median urinary albumin excretion was 67 mg/g (range = 25–136 mg/g) and it increased to 625 mg/g (range = 9–13471 mg/g) after 4 years; 10 subjects (63 %; 4 men, 6 women) developed macroalbuminuria (urinary albumin-to-creatinine ratio ≥ 300 mg/g). Neither mean arterial pressure nor HbA1 c changed substantially during follow-up. Among the glomerular morphologic characteristics, the number of visceral epithelial cells, or podocytes, per glomerulus was the strongest predictor of renal disease progression (UAE4 years, r = –0.49, p = 0.05; ΔUAE, r = –0.57, p = 0.02), with fewer cells predicting more rapid progression. Glomerular basement membrane thickness did not predict progression (UAE4 years, r = 0.11, p = 0.67; ΔUAE, r = 0.09, p = 0.73) and mesangial volume fraction had only a modest effect (UAE4 years, r = 0.42, p = 0.11; ΔUAE, r = 0.48, p = 0.06). Conclusion/interpretation. Whether lower epithelial cell number per glomerulus among those that progressed was due to cellular destruction, a reduced complement of epithelial cells, or both is uncertain. Nevertheless, these findings suggest that podocytes play an important part in the development and progression of diabetic renal disease. [Diabetologia (1999) 42: 1341–1344]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051447
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  • 8
    Electronic Resource
    Electronic Resource
    Albuminuria in Type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians (1989)
    Springer
    Diabetologia 32 (1989), S. 870-876 
    Details
    ISSN: 1432-0428
    Keywords: Albuminuria ; prevalence ; diabetic nephropathy ; Type 2 (non-insulin-dependent) diabetes mellitus ; impaired glucose tolerance ; American Indians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The prevalence of abnormal urinary albumin excretion, defined by a urine albumin to creatinine ratio〉-30 mg/g (approximately equivalent to an albumin excretion rate of 〉-30 mg/24 h), was determined in 2728 Pima Indians aged 〉-15 years from the Gila River Indian Community in Arizona, a population with a high prevalence of Type 2 (non-insulin-dependent) diabetes mellitus. Excessive albumin excretion was present in 8% of subjects with normal glucose tolerance, 15% of those with impaired glucose tolerance, and 47% of subjects with diabetes. The intermediate prevalence of abnormal albuminuria in those with impaired glucose tolerance suggests that hyperglycaemia even at levels below those diagnostic of diabetes is associated with renal abnormalities in some subjects and that these abnormalities may precede the onset of diabetes. Abnormal albuminuria at levels not reliably detected by the usual dipstick methods was commonly observed in Pima Indians with diabetes, even those with diabetes of recent onset. Associations were found with age, duration of diabetes, level of glycaemia, blood pressure, and treatment with insulin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00297452
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  • 9
    Electronic Resource
    Electronic Resource
    Parental hypertension and proteinuria in Pima Indians with NIDDM (1996)
    Springer
    Diabetologia 39 (1996), S. 433-438 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Diabetic nephropathy ; hypertension ; familial predisposition ; non-insulin-dependent diabetes mellitus ; Pima Indians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To determine if parental hypertension is associated with proteinuria in offspring with non-insulin-dependent diabetes mellitus (NIDDM), 438 diabetic Pima Indians (172 men, 266 women) aged 20 years or more and both of their parents were examined. Hypertension was defined as a systolic blood pressure 140 mm Hg or more, diastolic blood pressure 90 mm Hg or more, or treatment with antihypertensive medicine. Sixty-three percent of the fathers and 80 % of the mothers had diabetes at the time their blood pressure was measured. Families in which either parent had proteinuria, defined as a urine protein-to-creatinine ratio ≥ 0.5 g/g were excluded; 73 (16.7 %) of the offspring had proteinuria. The prevalence rates of proteinuria in the offspring were similar if neither parent or only one parent had hypertension (8.9 and 9.4 %, respectively), but was significantly higher if both parents had hypertension (18.8 %), after adjustment for age, sex, duration of diabetes, and 2-h post-load plasma glucose concentration in the offspring and diabetes in the parents by logistic regression. The odds for proteinuria being present in the offspring if both parents had hypertension was 2.2 times (95 % confidence interval, 1.2 to 4.2) that if only one parent had hypertension. When mean arterial pressure and blood pressure treatment in the offspring were added to the model the relationship remained (odds ratio = 2.2; 95 % confidence interval, 1.1 to 4.3). Hypertension in both parents is associated with the development of proteinuria in offspring with NIDDM. This relationship was present even when controlled for the effects of blood pressure and its treatment in the offspring. [Diabetologia (1996) 39: 433–438]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400674
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  • 10
    Electronic Resource
    Electronic Resource
    Changing glomerular filtration with progression from impaired glucose tolerance to Type II diabetes mellitus (Short Communications) (1999)
    Springer
    Diabetologia 42 (1999), S. 90-93 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Diabetic Renal Disease Study ; glomerular filtration rate ; impaired glucose tolerance ; Type II diabetes ; Pima Indians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glomerular filtration rate (iothalamate clearance) was measured serially for 48 months in 26 Pima Indians with impaired glucose tolerance and 27 with normal glucose tolerance. At baseline, the mean glomerular filtration rate (SEM) was 133 ± 8 ml/min in subjects with impaired glucose tolerance and 123 ± 5 ml/min in those with normal glucose tolerance (p = 0.12). In the 12 subjects with impaired glucose tolerance who progressed to Type II (non-insulin-dependent) diabetes during follow-up, mean glomerular filtration rate increased by 30 % (p = 0.011). Among the remaining 14 subjects with impaired glucose tolerance, 12 reverted to normoglycaemia. The glomerular filtration rate both at baseline and after 48 months in this subgroup exceeded the values of subjects with normal glucose tolerance by 20 % (p = 0.008) and 14 % (p = 0.013), respectively. A pronounced rise in the glomerular filtration rate occurs at the onset of Type II diabetes but a trend to hyperfiltration is also present in those with impaired glucose tolerance. [Diabetologia (1999) 42: 90–93]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051118
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