Microalbuminuria in type 1 diabetes: Rates, risk factors and glycemic threshold

• Published in: Kidney international Vol. 60; no. 1; pp. 219 - 227
• Main Authors: Chaturvedi, Nish, Bandinelli, Simona, Mangili, Ruggero, Penno, Guiseppe, Rottiers, Raoul E., Fuller, John H.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2001; Nature Publishing; Elsevier Limited
• Subjects: Adolescent; Adult; albuminuria; Albuminuria - epidemiology; Albuminuria - urine; Associated diseases and complications; Biological and medical sciences; Blood Glucose - metabolism; blood sugar control; Body Constitution; cardiovascular disease; Cohort Studies; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - urine; Diabetes. Impaired glucose tolerance; Differential Threshold; Disease Progression; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Europe; Female; Follow-Up Studies; Humans; Incidence; insulin resistance; Insulin Resistance - physiology; Male; Medical sciences; Middle Aged; Prospective Studies; Reference Values; renal disease; Risk Factors; Triglycerides - blood; Europe; cardiovascular disease; albuminuria; blood sugar control; insulin resistance; renal disease; Endocrinopathy; Human; Immunopathology; Urinary system disease; Albumin; Biological marker; Autoimmune disease; Triglyceride; Insulin; Incidence; Protein hormone; Hypoglycemic agent; Risk factor; Insulin dependent diabetes; Negative therapeutic reaction; Microalbuminuria; Proteinuria
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.2001.00789.x

Microalbuminuria in type 1 diabetes: Rates, risk factors and glycemic threshold.
The occurrence of microalbuminuria in type 1 diabetes is strongly predictive of renal and cardiovascular disease and is still likely to occur despite improvements in glycemic control. A better understanding of microalbuminuria is required to inform new interventions. We determined the incidence and risk factors for microalbuminuria [albumin excretion rate (AER) 20 to 200 μg/min] in the EURODIAB Prospective Complications Study.
This is a seven-year follow-up (between 1988 and 1991) of 1134 normoalbuminuric men and women (aged 15 to 60) with type 1 diabetes from 31 European centers. Risk factors and AER were measured centrally.
The incidence of microalbuminuria was 12.6% over 7.3 years. Independent baseline risk factors were HbA1c (7.1 vs. 6.2%, P = 0.0001) and AER (9.6 vs. 7.8 μg/min, P = 0.0001) and, independent of these, fasting triglyceride (0.99 vs. 0.88 mmol/L, P = 0.01), low-density lipoprotein cholesterol (3.5 vs. 3.2 mmol/L, P = 0.02), body mass index (24.0 vs. 23.4 kg/m2, P = 0.01), and waist to hip ratio (WHR; 0.85 vs. 0.83, P = 0.009). Triglyceride and WHR risk factors were nearly as strong as AER in predicting microalbuminuria (standardized regression effects of 1.3 for triglyceride and WHR and 1.5 for AER). Blood pressure at follow-up, but not at baseline, was also raised in those who progressed. There was no evidence of a threshold of HbA1c on microalbuminuria risk.
The incidence of microalbuminuria in patients with type 1 diabetes remains high, and there is no apparent glycemic threshold for it. Markers of insulin resistance, such as triglyceride and WHR, are strong risk factors. Systemic blood pressure is not raised prior to the onset of microalbuminuria.