Control of Blood Glucose in Diabetics on CAPD

Abstract

The relationship between diabetic control and the incidence of vascular complications remains a subject of controversy. Hyperglycemia induces glycosylation of different proteins, sorbitol accumulation, disturbance in the function of blood cells, hyperlipoproteinemia and osmotic changes. Pathological studies show that the kidneys of diabetics and kidneys transplanted to diabetics undergo capillary basement-membrane thickening. Clinical studies using a variety of criteria for assessing control clearly show a relationship between hyperglycemia and microvascular, but not macrovascular complications. Animal studies indicate that vascular changes are secondary to the metabolic derangements of diabetics and that they improve with better control. Thus, the data available indicate a strong relationship between diabetic control and microvascular complications, but there is no evidence that hyperglycemia per se is a significant risk factor for macrovascular disease. However, the relationship to microvascular complications makes it highly desirable to strive for strict control of hyperglycemia, especially in young diabetics.