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Endocrinol Diabetes Metab Case Rep. 2018 Jan 8;2018. pii: 17-0136. doi: 10.1530/EDM-17-0136. eCollection 2018.

Preservation of renal function by intensive glycemic control.

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Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.
Department of Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
Department of Pathology, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Department of Nephrology, Kyoto University Graduate School of Medicine, Japan.


We report the case of a 67-year-old Japanese woman with type 1 diabetes mellitus. At 47 years of age, her hemoglobin A1c (HbA1c) was 10.0%, and she had overt nephropathy. The first renal biopsy yielded a diagnosis of diabetic nephropathy. Intensive glycemic control was initiated and her HbA1c improved to 6.0%. Renal dysfunction showed no progression for 15 years. At 62 years of age, a second renal biopsy was performed. Glomerular lesions did not show progression but tubulointerstitial fibrosis and vascular lesions showed progression compared with the first biopsy. Intensive glycemic control can prevent the progression of glomerular lesions, but might not be effective for interstitial and vascular lesions.

Learning points:

Intensive control of blood glucose can prevent the progression of glomerular lesions.Intensive control of blood glucose may not be able to prevent progression of interstitial and vascular lesions.CSII reduces HbA1c without increasing the risk of hypoglycemia.

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