Urinary Albumin Excretion as a Predictor of Diabetic Retinopathy, Neuropathy, and Cardiovascular Disease in NIDDM

Savage, Susan; Estacio, Raymond O.; Jeffers, Barrett W.; Schrier, Robert W.

doi:10.2337/diacare.19.11.1243

Cited by 153 publications

(100 citation statements)

References 36 publications

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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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Section: Introductionmentioning

confidence: 99%

Rosiglitazone reduces urinary albumin excretion in type II diabetes

et al. 2003

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“…Low HRV is associated with mortality risk in post-myocardial infarction patients [23,24] and also in the general population [25,26]. Also, autonomic neuropathy has been proposed to play a role in the aetiology of cardiovascular disease [27,28,29,30,31] and nephropathy [32,33] in diabetes. So far, the agreement between the autonomic functions tests, their reproducibility and reference values have not been reported in a single study.…”

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confidence: 99%

Measures of cardiovascular autonomic nervous function: agreement, reproducibility, and reference values in middle age and elderly subjects

et al. 2003

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Aims/hypothesis. Currently, three categories of cardiovascular autonomic nervous function measures are used: classic Ewing-test measures, measures of heartrate variability (HRV), and measures of baroreflex sensitivity (BRS). Little is known about the agreement between these measures, and reference and reproducibility values for these measures have not been reported within the same group. Methods. As part of the Hoorn Study, 631 subjects aged 50 to 75 participated in a study of autonomic nervous function. Cardiac cycle duration (RR interval) and continuous finger arterial pressure were measured under three conditions: during spontaneous breathing, during six deep breaths over 1 min, and during an active change in position from lying to standing. From these readings, ten measures of autonomic function were assessed (mean heart rate, three Ewing test measures, five HRV measures and one BRS measure). Results. Regression analysis in a healthy subgroup (n=191) showed sex differences for two of the ten measures and seven measures decreased with age. Therefore, appropriate age-specific and sex-specific reference values were calculated. Reproducibility (n=39) of most measures was moderate, with a reliability coefficient of around 50%. Agreement between the measures of autonomic nervous function varied greatly, between 0% and 87%. The HRV-power ratio measure and the blood pressure changes in the lyingto-standing test showed the lowest agreement with all other measures. Conclusion/Interpretation. This study provides agespecific and sex-specific reference values for a wide range of different autonomic function measures in an elderly population. Agreement among the different measures varied widely and reproducibility was only moderate. [Diabetologia (2003) 46:330-338] Keywords Aging, agreement, baroreflex, diabetes mellitus, heart-rate variability, nervous system, autonomic, reference values, reproducibility.

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“…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.…”

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

confidence: 64%

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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Urinary Albumin Excretion as a Predictor of Diabetic Retinopathy, Neuropathy, and Cardiovascular Disease in NIDDM

Cited by 153 publications

References 36 publications

Rosiglitazone reduces urinary albumin excretion in type II diabetes

Rosiglitazone reduces urinary albumin excretion in type II diabetes

Measures of cardiovascular autonomic nervous function: agreement, reproducibility, and reference values in middle age and elderly subjects

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

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