Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European Type 2 (non-insulin-dependent) diabetic patients

Abstract

The prevalence of micro- and macroalbuminuria was determined in Type 2 (non-insulin-dependent) diabetic patients, less than 76 years of age, attending a diabetic clinic during 1987. All eligible patients (n = 557) were asked to collect a 24-h urine sample for quantitative albumin analysis. Urine collections were obtained in 296 males and 253 females (96%). Normoalbuminuria were defined as urinary albumin excretion less than or equal to 30 mg/24 h (n = 323), microalbuminuria as 31-299 mg/24 h (n = 151), and macroalbuminuria as greater than or equal to 300 mg/24 h (n = 75). The prevalence of macroalbuminuria was significantly higher in males (20%) than in females (6%), while the prevalence of microalbuminuria was almost identical in males (26%) and females (29%). The prevalence of arterial hypertension increased with increased albuminuria, being 48%, 68%, and 85% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of proliferative retinopathy rose with increasing albuminuria, being 2%, 5% and 12% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of coronary heart disease, based on Minnesota coded electrocardiograms, was more frequent in patients with macroalbuminuria (46%) compared to patients with microalbuminuria (26%) and patients with normoalbuminuria (22%). Foot ulcers were more frequent in micro- and macroalbuminuric patients, being 13% and 25%, respectively, compared to 5% in patients with normoalbuminuria. This cross-sectional study has revealed a high prevalence of microalbuminuria (27%) and macroalbuminuria (14%) in Type 2 diabetic patients. Patients with raised urinary albumin excretion are characterized by obesity, elevated haemoglobin Alc, increased frequency of arterial hypertension, proliferative retinopathy, coronary heart disease and foot ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary artery disease, microalbuminuria and lipid profile in patients with non-insulin dependent diabetes mellitus

“…Confirming other reports in the literature, the frequency of hypertension in our sample was 58.2%, being more common in patients with microalbuminuria 19,22,24 and overweight 28 . We observed that 19 (59.4%) treated patients, still had blood pressure levels over 140/90mmHg, in spite of the fact that 43% of them had already been using two or more antihypertensive drugs, demonstrating inadequate pressoric control, according to the levels suggested by the American Diabetes Association and the Joint National Committee 29 .…”

“…The classical results reported in the Framingham study suggest that the presence of risk factors adversely affects the development of macrovascular disease both in nondiabetic and NIDDM patients 33 . In our group, CAD frequency was 43.6%, similar to the 40 to 50% 24,34 reported in the literature. We observed that there was a greater prevalence of hypertension in these patients, with a risk ratio of 3.7 for coronary disease, confirming prior reports in the literature.…”

“…The frequency of microalbuminuria in our group was 45.5%, with a tendency for increased systolic blood pressure, duration of the diabetes and hypertension In the stepwise multiple regression analysis, systolic blood pressure was the only variable that significantly influenced the rate of UAE. We did not observe a relation between HbA1c and microalbuminuria, sometimes reported 24,25 or not 26,27 in the literature. Possibly, transverse cohort studies, such as ours, are less likely to reveal the influence of glycemic control on the development of microalbuminuria.…”

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

“…A 12-lead ECG was recorded and subsequently coded independently by two trained observers using Minnesota codes [11]. Known ischaemic heart disease was diagnosed based on the history or an ECG suggestive of myocardial infarction or myocardial ischaemia [5]. Left ventricular hypertrophy was diagnosed by Sokolow-Lyon voltage criteria.…”

“…Early identification of vascular risk is the cornerstone of diabetes management and facilitates tailored intervention at an early stage when a beneficial response is more likely to be obtained. Screening for microalbuminuria identifies diabetic patients at increased risk of overt diabetic nephropathy; microalbuminuria is, however, also strongly associated with cardiovascular disease [4,5]. Furthermore, an elevated plasma NT-proBNP level predicts excess mortality in type 1 diabetic nephropathy [6] and an increased incidence of major cardiovascular events in microalbuminuric type 2 diabetic patients [7].…”