Albuminuria and poor glycemic control predict mortality in NIDDM

Gall, Mari-Anne; Borch‐Johnsen, Knut; Hougaard, Philip; Nielsen, F. S.; Parving, Hans‐Henrik

doi:10.2337/diabetes.44.11.1303

Cited by 273 publications

(157 citation statements)

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“…The study population was based on all subjects (n=363) with type 2 diabetes who were <66 years of age and attending the Hvidöre Hospital, a tertiary referral centre, during 1987 (baseline [8]). Type 2 diabetes was defined as: (1) diabetes treated by diet alone or by diet combined with oral hypoglycaemic agents; (2) diabetes treated with insulin plus onset of diabetes after the age of 40 years and with patient BMI above normal at time of diagnosis; or (3) diabetes treated with insulin, with patients having a normal BMI and a glucagon-stimulated C-peptide value ≥0.60 pmol/ml.…”

Section: Study Population and Protocolmentioning

confidence: 99%

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

et al. 2006

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Aims/hypothesis Raised N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with a poor cardiac outcome in non-diabetic populations. Elevated NT-proBNP predicts excess morbidity and mortality in diabetic patients with an elevated urinary albumin excretion rate. This study investigated the prognostic value of NT-proBNP in a cohort of type 2 diabetic patients. Subjects, materials and methods In a prospective observational follow-up study, 315 type 2 diabetic patients with normoalbuminuria (n=188), microalbuminuria (n=80) and macroalbuminuria (n=47) at baseline were followed for a median (range) of 15.5 (0.2-17.0) years. Plasma NTproBNP concentrations were determined by immunoassay at baseline. Endpoints were overall and cardiovascular mortality. Results Of the patients, 162 died (51%), 119 of them (74%) due to cardiovascular causes. All-cause mortality was increased in patients with NT-proBNP .02], p=0.01). When patients with normo-, micro-and macroalbuminuria were analysed separately, NT-proBNP levels above the median (62 ng/l) were consistently associated with increased overall and cardiovascular mortality in all three groups (p<0.001). Conclusions/interpretation In patients with type 2 diabetes, elevated circulating NT-proBNP is a strong predictor of the excess overall and cardiovascular mortality, this predictor status being independent of urinary albumin excretion rate and conventional cardiovascular risk factors.

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Section: Study Population and Protocolmentioning

confidence: 99%

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

et al. 2006

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“…It is considered to be an early indicator of renal and cardiovascular disease risk, 2,3 as well as of an increased risk of all-cause mortality. 4,5 Thus, microalbuminuria is an indication for aggressive intervention to improve glycaemic and blood pressure (BP) control and to reduce cardiovascular risk factors.…”

Section: Introductionmentioning

confidence: 99%

Rosiglitazone reduces urinary albumin excretion in type II diabetes

et al. 2003

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This study examines the effect of rosiglitazone on urinary albumin excretion (UAE) in patients with type II diabetes. Urinary albumin : creatinine ratio (ACR) was measured in a 52-week, open-label, cardiac safety study comparing rosiglitazone and glyburide. Patients were randomised to treatment with rosiglitazone 4 mg b.i.d. or glyburide. ACR was measured at baseline and after 28 and 52 weeks of treatment. Statistically significant reductions from baseline in ACR were observed in both treatment groups at week 28. By week 52, only the rosiglitazone group showed a significant reduction from baseline. Similar results were observed for the overall study population and for the subset of patients with baseline microalbuminuria. For patients with microalbuminuria at baseline, reductions in ACR did not correlate strongly with reductions in glycosylated haemoglobin, or fasting plasma glucose, but showed strong correlation with changes in mean 24-h systolic and diastolic blood pressure for rosiglitazone-treated patients (DACR vs Dmean 24-h systolic blood pressure, r ¼ 0.875; DACR vs Dmean 24-h diastolic blood pressure, r ¼ 0.755; Po0.05 for both). No such correlation was observed for glyburide-treated patients. In conclusion, rosiglitazone treatment was associated with a decrease in urinary albumin excretion. These findings suggest a potential beneficial effect of rosiglitazone in the treatment or prevention of renal and vascular complications of type II diabetes.

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“…the main determinants of morbidity and mortality in type 1 [1] and type 2 diabetic patients [2]. In both types of diabetes, microalbuminuria is related to increases in a number of markers of endothelial dysfunction [3,4], which is why microalbuminuria is considered a marker of the risk of atherosclerosis and cardiovascular disease [5].…”

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confidence: 99%

Relationship between glyco-oxidation, antioxidant status and microalbuminuria in type 2 diabetic patients

et al. 2009

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Aims/hypothesis This study examined the relationship, if any, between glucose-induced oxidative stress, antioxidant status and microalbuminuria in patients with type 2 diabetes. Methods The study involved 99 consecutive type 2 diabetic patients (57 men, 42 women). Patients with persistent microalbuminuria were identified and the following variables evaluated: fasting plasma glucose, HbA 1c , malonyldialdehyde (MDA), pentosidine, AGE, the total radical-trapping antioxidant parameter (TRAP), vitamin E, creatinine, estimated GFR and lipid profile. Results Patients were divided into two groups, i.e. 37 individuals without microalbuminuria (AER <20 μg/min) and 62 with microalbuminuria (AER ≥20 μg/min). The following variables were significantly higher in patients with microalbuminuria than in those without microalbuminuria (mean ± SD): fasting plasma glucose 9.41±2.88 vs 8.19±1.93 mmol/l, p<0.05; HbA 1c 7.97±1.51 vs 7.39± 1.03%, p<0.05; MDA 1.18±0.35 vs 1.02±0.29 µmol/l, p< 0.05; pentosidine 98.5±24.6 vs 82.9±20.9 pmol/ml, p< 0.005; and AGE 13.2±4.8 vs 10.6±3.8 µg/mg protein, p< 0.01. However, vitamin E and TRAP did not differ between the two groups. Serum creatinine values and estimated GFR were similar in the two groups. Only in patients with microalbuminuria were significant linear correlations seen between AER and both oxidation (HbA 1c r=0.33, p<0.01; MDA r=0.59, p<0.001; pentosidine r=0.48, p<0.001; and AGE r=0.44, p<0.001) and antioxidation variables (vitamin E r=−0.55, p<0.001; TRAP r=−0.49, p<0.001). Considering all variables together, multiple regression revealed a correlation between microalbuminuria and vitamin E, TRAP, HbA 1c and MDA, but not pentosidine or AGE. Conclusions/interpretation Our data suggest that microalbuminuria in type 2 diabetic patients might be promoted by an insufficient counter-regulation of the antioxidant system in the event of increased glyco-oxidation/glycation.

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Albuminuria and poor glycemic control predict mortality in NIDDM

Cited by 273 publications

References 0 publications

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

Rosiglitazone reduces urinary albumin excretion in type II diabetes

Relationship between glyco-oxidation, antioxidant status and microalbuminuria in type 2 diabetic patients

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