Development and Progression of Renal Disease in Pima Indians with Non-Insulin-Dependent Diabetes Mellitus

Background Non-insulin-dependent diabetes mellitus (NIDDM) is a major cause of end-stage renal disease. However, the course and determinants of renal failure in this type of diabetes have not been clearly defined. Methods We studied glomerular function at intervals of 6 to 12 months for 4 years in 194 Pima Indians selected to represent different stages in the development and progression of diabetic renal disease. Initially, 31 subjects had normal glucose tolerance, 29 had impaired glucose tolerance, 30 had newly diagnosed diabetes, and 104 had had diabetes for five years or more; of these 104, 20 had normal albumin excretion, 50 had microalbuminuria, and 34 had macroalbuminuria. The glomerular filtration rate, renal plasma flow, urinary albumin excretion, and blood pressure were measured at each examination. Results Initially, the mean (±SE) glomerular filtration rate was 143±7 ml per minute in subjects with newly diagnosed diabetes, 155±7 ml per minute in those with microalbuminuria, and 124±7 ml per min...