Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Abstract

Aims/hypothesis. Type 1 diabetic patients who develop microalbuminuria are clearly disadvantaged in terms of their risk of morbidity and mortality from renal and cardiovascular diseases. It is therefore important to identify potential factors that can predict progression to macroalbuminuria. Methods. This is a 7-year follow-up study of 352 microalbuminuric Type 1 diabetic patients from 31 European centres. Risk factors at baseline were compared in patients who progressed to macroalbuminuria and in patients who remained microalbuminuric or reverted to normoalbuminuria. Risk factors and albumin excretion rate (AER) were measured centrally. Results. Over 7.3 years, 13.9% of the microalbuminuric patients progressed to macroalbuminuria, 35.5% remained microalbuminuric and 50.6% reverted to normoalbuminuria. Independent baseline risk factors for progression to macroalbuminuria were HbA 1 c (7.9% vs 6.8%, p=0.004), AER (64.4 vs 44.9 µg/min, p=0.0001) and-after adjusting for diabetes duration, HbA 1 c and AER-body weight (72 vs 67 kg, p=0.05). Independent factors associated with regression to normoalbuminuria were diabetes duration (15 vs 18 years, p=0.004), AER (37.2 vs 44.9 µg/min, p=0.0001) andafter adjusting for diabetes duration, HbA 1 c and AER-waist-to-hip ratio (0.83 vs 0.86, p=0.05) and incidence of peripheral neuropathy at baseline (24% vs 38%, p=0.001). Blood pressure and smoking did not emerge as risk factors at baseline for the outcome of microalbuminuria. Conclusions/interpretation. A significant fraction of microalbuminuric Type 1 diabetic patients will progress to overt proteinuria. Patients with higher AER values, sub-optimal metabolic control, excess body fat and peripheral neuropathy may carry a particularly high risk of clinical nephropathy requiring aggressive therapeutic intervention.

Long-term prevention of diabetic nephropathy: an audit

“…This is in accordance with previous observational studies finding the same association between poor glycaemic control and progression in albuminuria and the rate of progression to DN [20,[22][23][24][25]. In our study, an effort was made to obtain improved glycaemic control by intensive nurse guidance.…”

Factors Associated with Microalbuminuria Remission in Patients with Type 2 Diabetes: Importance of Early Intervention for Microalbuminuric Patients (TSUGARU STUDY)

“…The increased use of these drugs could be attributed to the additional comments about the current standard management of DN at registration from the study office. Although this study was not an interventional study, these results suggest that the clinicians in the region gradually gained more knowledge on the diagnosis and management of DN throughout the duration of this study.Compared to the results from several studies which that showed the rate of microalbuminuria remission in DN (8,[11][12][13][14][15][16], the rate found in the present study, 27.4%, was not very high. Most of the contributors in this study were general physicians, not diabetes specialists, many previous papers on DN were reported from diabetic specialist faculties, such as, university hospitals or diabetic centers (8,(11)(12)(13)(14)(15)(16).…”

“…Most of the contributors in this study were general physicians, not diabetes specialists, many previous papers on DN were reported from diabetic specialist faculties, such as, university hospitals or diabetic centers (8,(11)(12)(13)(14)(15)(16). Consequently, our results in this study might accurately reflect the situation of actual clinical practice.…”

Lipid abnormalities predict progression of renal disease in patients with type 1 diabetes

“…However, this could have been because of lack of power, since triacylglycerol and ApoA-I/ApoA-II and HDL 2 -/HDL 3 -cholesterol ratio predicted progression of renal disease independently of AER when patients with normal AER and microalbuminuria were pooled. In the EURODIAB and Pittsburgh Epidemiology of Diabetes Complications studies, triacylglycerol did not predict the progression to macroalbuminuria [17,28].…”

“…In contrast, the EURODIAB study included a large number of patients with type 1 diabetes from different parts of Europe and also a much larger number of patients who progressed with respect to their renal disease. It is, however, of note that the patients in the EURODIAB study were recruited between 1988 and 1991, represented 16 different countries with varying diets and undoubtedly represent a rather heterogeneous genetic mixture [16,17].…”