Patient-Specific Considerations
Barbosa et al. described a prospective randomized study that evaluated over five years the effect of tight glycemic control in insulin-dependent diabetes mellitus (IDDM) patients to prevent diabetic nephropathy in the transplanted kidneys of recipients who were transplanted secondary to diabetic nephropathy. Patients were randomly assigned to receive either standardized or maximized insulin treatment. Results indicated that the patients who were given the maximized insulin therapy demonstrated significantly less renal pathology closely associated with the diabetic nephropathy. As with the DCCT trial, the results of this study also noted a higher incidence of hypoglycemia in the group with tighter glucose control.