The Natural History and Associations of Microalbuminuria in Type 2 Diabetes During the First Year After Diagnosis

Patrick, A.W.; Leslie, Peter; Clarke, B F; Frier, Brian M.

doi:10.1111/j.1464-5491.1990.tb01326.x

Cited by 51 publications

(36 citation statements)

References 21 publications

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“…Many factors contribute to this: race, diabetes duration, microalbuminuria criteria and size and design of the studies. Similar to the present study, several other reports in the literature associate microalbuminuria with systolic blood pressure 7,19,21 . The association with diastolic blood pressure is less evident.…”

Section: Arq Bras Cardiol Volume 73 (Nº 1) 1999supporting

confidence: 81%

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

Bahia¹,

Gomes²,

Cruz³

et al. 1999

Arq. Bras. Cardiol.

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Diabetes mellitus is an important factor associated with increased cardiovascular morbidity and mortality, due to coronary artery disease (CAD), stroke and peripheral vascular disease. Age adjusted coronary artery disease prevalence in diabetic patients, in the United States, is between 30 and 51%; peripheral vascular disease and stroke prevalences are 9 and 10%, respectively 1 . Recently, a study in Brazil reported a 2.3 greater in-hospital mortality rate in diabetic compared with nondiabetic patients, and the main cause of death was cardiovascular disease 2 .Today, it is recognized that the presence of microalbuminuria, in addition to being a marker of incipient renal disease in diabetic patients, seems to be also a marker of large vessel disease, and is associated with an increased cardiovascular disease mortality, especially coronary heart disease 3-5 . This increased mortality is due, in part, to a greater prevalence of other risk factors in patients with microalbuminuria, such as lipid disorders, hypertension (H), increased fibrinogen levels and blood rheology changes 6,7 . Recent studies from the World Health Organization demonstrated that the presence of proteinuria, in type 2 diabetic patients (DM2), increased the risk of cardiovascular death 3 to 4 times, independent of other risk factors 8 .The presence of microalbuminuria possibly reflects the process of generalized vascular damage, affecting simultaneously glomeruli, the retina and the intimal layer of large vessels. This has been demonstrated by studies of markers of endothelial dysfunction and measurements of transcapillary protein leakage 9,10 .Some studies suggested a common genetic predisposition for microalbuminuria and the early atherosclerotic process in diabetic patients 11 . Others suggested that glomerular mesangeal cells and arterial smooth muscle cells, being both of mesenchimal origin, would suffer the same changes in response to the different metabolic abnormalities observed in these patients, such as functional extracellular matrix changes with the consequent mesangial and medial proliferation, endothelial dysfunction and protein leakage 9 .The present study aimed to analyze the association between coronary artery disease, incipient diabetic renal

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Section: Arq Bras Cardiol Volume 73 (Nº 1) 1999supporting

confidence: 81%

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

Bahia¹,

Gomes²,

Cruz³

et al. 1999

Arq. Bras. Cardiol.

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“…Treatment for hypertension was similar in both groups and applied guidelines from multiple sources (8,11,12,(16)(17)(18). Treatment of lipoprotein disorders was also similar in both groups (3).…”

Section: Intensive Treatmentmentioning

confidence: 86%

“…To define microalbuminuria, we used a ratio of albumin to creatinine (11)(12)(13)(14)(15)(16). Microalbuminuria was indicated with a urinary albumin:creatinine ratio (both reported in milligrams per 100 ml) of 0.03-0.30.…”

Section: Intensive Treatmentmentioning

confidence: 99%

Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators.

et al. 2000

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OBJECTIVE -Microalbuminuria can reflect the progress of microvascular complications and may be predictive of macrovascular disease in type 2 diabetes. The effect of intensive glycemic control on microalbuminuria in patients in the U.S. who have had type 2 diabetes for several years has not previously been evaluated. RESEARCH DESIGN AND METHODS-We randomly assigned 153 male patients to either intensive treatment (INT) (goal HbA 1c 7.1%) or to standard treatment (ST) (goal HbA 1c 9.1%; P = 0.001), and data were obtained during a 2-year period. Mean duration of known diabetes was 8 years, mean age of the patients was 60 years, and patients were well matched at baseline. We obtained 3-h urine samples for each patient at baseline and annually and defined microalbuminuria as an albumin:creatinine ratio of 0.03-0.30. All patients were treated with insulin and received instructions regarding diet and exercise. Hypertension and dyslipidemia were treated with similar goals in each group.RESULTS -A total of 38% of patients had microalbuminuria at entry and were evenly assigned to both treatment groups. INT retarded the progression of microalbuminuria during the 2-year period: the changes in albumin:creatinine ratio from baseline to 2 years of INT versus ST were 0.045 vs. 0.141, respectively (P = 0.046). Retardation of progressive urinary albumin excretion was most pronounced in those patients who entered the study with microalbuminuria and were randomized to INT. Patients entering with microalbuminuria had a deterioration in creatinine clearance at 2 years regardless of the intensity of glycemic control. In the group entering without microalbuminuria, the subgroup receiving ST had a lower percentage of patients with a macrovascular event (17%) than the subgroup receiving INT (36%) (P = 0.03). Use of ACE inhibitors or calcium-channel blockers was similarly distributed among the groups.CONCLUSIONS -Intensive glycemic control retards microalbuminuria in patients who have had type 2 diabetes for several years but may not lessen the progressive deterioration of glomerular function. Increases in macrovascular event rates in the subgroup entering without albuminuria who received INT remain unexplained but could reflect early worsening, as observed with microvascular disease in the Diabetes Control and Complications Trial.

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“…Persistent microalbuminuria (i. e. a urinary albumin excretion (UAE) from 20 ~g/min to 200 ~g/min) in patients with IDDM defines the state of incipient nephropathy [3], which is the state from which approximately 80 % progress to overt nephropathy over the next decade. Microalbuminuria [4,[6][7][8][9][10][11], and often present at diagnosis or at early known durations [4,[11][12][13][14][15][16]. Microalbuminuria in NIDDM obviously do also predict the development of clinical proteinuria [17], which will progress in some cases to renal failure, but with far less consistency than is seen in IDDM [18].…”

mentioning

confidence: 99%

Systolic blood pressure relates to the rate of progression of albuminuria in NIDDM

1994

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SummaryWe prospectively followed a cohort of 278 non-insulin-dependent (NIDDM) patients for a 6-year period, intending to estimate the rate of increase of albuminuria and to identify clinical variables that influence this increase. At baseline, normoalbuminuria (N) was seen in 74 %, microalbuminuria (M) in 19 % and 7 % presented with proteinuria (P). A total of 80patients died; they were older (p < 0.001) and had higher albumin excretion both at baseline and as an average during follow-up (p < 0.01). At baseline, patients with proteinuria had higher blood pressures (systolic and diastolic), whereas there was no difference between patients with normo-and microalbuminuria. Glycaemic control was increasingly poor throughout the three groups. At follow-up, an average relative rate of increase of albuminuria (slope) of 17 % per year was seen both for patients with complete 6 years, follow-up (n = 135) and patients with at least 4 years follow-up (n = 178). Slope correlated significantly with systolic blood pressure (r = 0.26 and 0.29) in both groups, diastolic blood pressure only in the 4-year group (r = 0.22) and average albuminuria in both (r = 0.31 and 0.24). By multiple regression analyses systolic blood pressure and average albuminuria remained with significant influence on slope. Progression was defined as an increase in the category (e. g. normoto microalbuminuria) as well as an increase of more than 20 % in albumin excretion, and was seen in 46 patients with at least 4 years' follow-up. Progressors (patients demonstrating progression) had higher systolic blood pressure (165 mmHg + 20 vs 156 + 17) and poorer glycaemic control (HbAm: 8.2 % + 1.5 vs 7.7 + 1.3) p < 0.05, as well as a higher level of albuminuria at baseline. The present study points to systolic blood pressure and general level of albuminuria as factors determining the rate of progression of albuminuria. However, only a modest fraction of the variation between subjects was explained by these variables. [Diabetologia (1994[Diabetologia ( ) 37: 1251[Diabetologia ( -1258 Key words Non-insulin-dependent diabetes mellitus, albuminuria, blood pressure, rate of progression, progressors, glycaemic control. Abbreviations: IDDM, insulin-dependent diabetes mellitus; NIDDM, non-insulin-dependent diabetes mellitus; N, normal urinary albumin excretion; M, microalbuminuria; R proteinuria; Slope, relative rate of increase; UAC, urinary albumin concentration; UAE, urinary albumin excretion rate.The natural development of diabetic nephropathy pertaining to patients with non-insulin-dependent diabetes (NIDDM) is poorly elucidated [1,2]. In insulin-dependent diabetes (IDDM) approximately 30 % of patients eventually develop end-stage renal failure [3], whereas in NIDDM the proportion is much lower (less than 10 %) at least in elderly Caucasian populations [4][5][6][7]. Persistent microalbuminuria (i. e. a urinary albumin excretion (UAE) from 20 ~g/min to 200 ~g/min) in patients with IDDM defines the state of incipient nephropathy [3], which is the state from which appr...

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The Natural History and Associations of Microalbuminuria in Type 2 Diabetes During the First Year After Diagnosis

Cited by 51 publications

References 21 publications

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

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

Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators.

Systolic blood pressure relates to the rate of progression of albuminuria in NIDDM

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