Microalbuminuria in Diabetic Patients: Relationship to Lipid, Glyco-metabolic, Coagulation and Fibrinolysis Parameters

Abstract

Summary:One hundred and sixteen insulin treated diabetic patients were evaluated for the relationship between the presence of microalbuminuria and several lipid, glyco-metabolic, coagulation and fibrinolysis factors. A significant correlation existed only between microalbuminuria and HbA lc (r = 0.23, p = 0.008) and D-dimer (r = 0.28, p = 0.002). After the subdivision of the patients in a group without (n = 85) and a group with microalbuminuria (n = 31) significant differences were found between these two groups for the HDL-cholesterol content (p < 0.05), the HbAi c level (p < 0.01) and for the D-dimer concentration (p < 0.01).Comparison of the patient groups without and with microalbuminuria separately with a healthy volunteers group without albuminuria resulted in significant differences for HDL-cholesterol, triacylglycerols, HbA lc , fructosamine, fibrin monömer and D-dimer, whereas fibrinogen also was significantly different between the diabetic group without microalbuminuria and the healthy volunteers group. Several factors predisposing for atherosclerosis (decrease of HDL-cholesterol, increase of triacylglycerols, coagulation activation with relatively msufficient fibrinolysis) were nöticed in both diabetic groups without or with microalbuminuria, but more pronounced in the latter group. The appliance of a Receiver Operating Characteristic (ROC) curve for HbA JC against microalbuminuria (cuf-off level 20 g/min) reconfirmed the value of adequate glycaemic control in diabetics for the prevention of microalbuminuria. In conclusion the results of this study show a significantly pporer glycaemic control in insulin treated diabetics with microalbuminuria than in those without microalbuminuria. The presence of lower HDL-cholesterol, higher triacylglycerols and the elevation of fibrin monomers and D-dimers is more pronoüiiced in the microalbuminuria group. No direct correlation could however be found between the coagulation.and fibrinolysis factors and the extent of microalbuminuria in the diabetic patient groups.

Association of D-dimer with microalbuminuria in patients with type 2 diabetes mellitus

“…Sialic acid, as well as other inflammatory markers, has been reported to be associated with atherosclerosis [28], and sialic acid has been reported to be significantly correlated with blood coagulation and fibrinolysis markers in patients with diabetes [29]. The above results of the present study in part agree with the finding of the Dutch group showing significant relationships of microalbuminuria with D-dimer as well as HbA1c and HDL cholesterol in insulin-treated diabetic patients that included patients with both type 1 and 2 diabetes [24], although the same group reported no association of microalbuminuria with D-dimer in patients with type 2 diabetes treated with oral hypoglycaemic agents [21]. Thus, one possible confounder of the relationship between microalbuminuria and D-dimer is history of insulin therapy.…”

“…No difference was found in levels of fibrinogen, TAT, D-dimer and PAI-1 in type 2 diabetes patients with microalbuminuria and levels in type 2 diabetes patients with normoalbuminuria [21,22], while PAI-1 and factor VII activity levels have been reported to be higher in type 1 diabetes patients with microalbuminuria than in those with normoalbuminuria [23]. On the other hand, in insulin-treated patients with diabetes, D-dimer but not TAT has been reported to be associated with microalbuminuria [24]. Thus, no consistent findings have been obtained on the relationships of microalbuminuria with blood coagulation and fibrinolysis, and the reason for this discrepancy remains unknown.…”

Prevalence of Microalbuminuria in Older-Onset Diabetes

“…A consistent positive relationship between hyperglycemia and microalbuminuria has been found in studies of younger-onset IDDM patients (5,6,8, 23,29,38-40), but not in older-onset NIDDM patients (29-31,33- 35,41,42). In this study, after controlling for other factors, an association between hyperglycemia was detected, as measured by GHb and microalbuminuria.…”

A history of HbA1c through Clinical Chemistry and Laboratory Medicine

“…Various studies were also published in the journal, demonstrating the biological consequences of glycation and glycoxidation on protein functions [65,66] especially in the case of lipoproteins [67 -69] . Besides, the link between serum protein glycation and urinary albumin excretion (incorrectly referred to as " microalbuminuria " ), another newly discovered marker of diabetic complications, was also underlined [70,71] .…”