Improvement in quality of diabetes control and concentrations of AGE-products in patients with type 1 and insulin-treated type 2 diabetes mellitus studied over a period of 10 years (JEVIN)

Schiel, Ralf; Franke, Sybille; Appel, Thilo; Voigt, Ulrich; Ross, Iain S.; Kientsch-Engel, Rosemarie; Stein, Günter; Müller, Ulrich A.

« Previous Next »Journal of Diabetes and Its Complications
Volume 17, Issue 2 , Pages 90-97, March 2003

Improvement in quality of diabetes control and concentrations of AGE-products in patients with type 1 and insulin-treated type 2 diabetes mellitus studied over a period of 10 years (JEVIN)

Ralf Schiel
- Department of Internal Medicine II, University of Jena Medical School, Jena, Germany
- Department of Ophthalmology, University of Jena Medical School, Jena, Germany
- Corresponding author. Department of Internal Medicine II, University of Jena Medical School, D-07740 Jena, Germany. Tel.: +49-3641-939769; fax: +49-3641-939639
Sybille Franke
- Department of Internal Medicine IV, University of Jena Medical School, Jena, Germany
Thilo Appel
- Department of Internal Medicine IV, University of Jena Medical School, Jena, Germany
Ulrich Voigt
- Department of Clinical Biochemistry, University of Aberdeen Medical School, Aberdeen, UK
Iain S. Ross
- Roche Diagnostics GmbH, Penzberg, Germany
Rosemarie Kientsch-Engel
- Roche Diagnostics GmbH, Penzberg, Germany
Günter Stein
- Department of Internal Medicine IV, University of Jena Medical School, Jena, Germany
Ulrich A. Müller
- Department of Internal Medicine II, University of Jena Medical School, Jena, Germany
- Department of Ophthalmology, University of Jena Medical School, Jena, Germany

Received 29 May 2002; accepted 12 July 2002.

Abstract

Advanced glycation end (AGE)-products, a complex and heterogeneous group of compounds, have been implicated in diabetes-related long-term complications. Up to the present, only few data exist about serum levels of the AGE-proteins N-ε-carboxymethyllysine (CML) and pentosidine in selection-free populations of patients with type 1 and insulin-treated type 2 diabetes mellitus. In the present 10-year, population-based trial of patients with insulin-treated diabetes mellitus, serum CML and pentosidine levels were examined in correlation to the patients' quality of diabetes control and the prevalence of diabetes-related long-term complications. Jena's St. Vincent Trial (JEVIN) was started in 1989/1990. At this time, a centralised diabetes care system existed. After the baseline examination of 190 patients (83% of the target population) with insulin-treated diabetes mellitus, follow-up examinations were performed in 1994/1995 and 1999/2000. In 1994/1995, the CML concentration in patients with type 1/type 2 diabetes mellitus was 1096.47±405.50/1136.43±405.24 ng/ml. In 1999/2000, it was significantly lower (727.49±342.91 ng/ml, P=.033/743.76±312.47 ng/ml, P<.0001). The same tendency showed the AGE-protein pentosidine (type 1: 1994/1995 203.18±118.88 vs. 1999/2000 156.59±104.84 pmol/ml [P=.029], type 2: 1994/1995 189.72±67.66 vs. 1999/2000 151.54±127.73 pmol/ml [P=.020]). Parallel to the decrease in the mean concentration of the AGE-products CML and pentosidine mean HbA1c improved and the prevalence of diabetic long-term complications (retino-, neuro-, and nephropathy) remained comparable 1999/2000–1989/1990. Comparing the data of 1999/2000 with those from 1994/1995, there was not only a substantial improvement in patients' quality of diabetes control but also a decrease in the concentration of AGE-products. In patients with diabetes mellitus, the AGE-products seem to be mainly influenced by the quality of diabetes control. However, the most important parameter reflecting the risk for development and progression of diabetes-related long-term complications seems not to be the AGE-products, but patients' HbA1c.

Keywords: Type 1 diabetes mellitus, Type 2 diabetes mellitus, HbA1c, Nephropathy, Creatinine, Albuminuria, AGE-products, N-ε-Carboxymethyllysine (CML), Pentosidine