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Predictors of the development of microalbuminuria in patients with Type 1 diabetes mellitus: a seven-year prospective study. The Microalbuminuria Collaborative Study Group.

Abstract

AIMS

To determine risk factors for the development of persistent microalbuminuria (albumin excretion rate (AER) > or =30 microg/min) in Type 1 diabetes mellitus.

METHODS

One hundred and forty-eight initially normotensive Type 1 diabetic patients with normal albumin excretion (<30 microg/min) were followed prospectively in hospital diabetes outpatient clinics for a median of 7 years. Main outcome measures were: progression to persistent microalbuminuria (albumin excretion rate > or =30 microg/min on at least two consecutive occasions); rate of change of albumin excretion rate; development of arterial hypertension (systolic blood pressure >160 mm Hg and/or diastolic blood pressure >95 mm Hg or commencement of antihypertensive therapy).

RESULTS

In a median follow-up period of 7 years (range 6 months to 8 years), 14 patients progressed to persistent microalbuminuria, a cumulative incidence of 11% (95% confidence interval 6.36-16.94). AER remained persistently <30 microg/min in 109 subjects and 25 developed intermittent microalbuminuria. In those who developed persistent microalbuminuria, baseline AER (16.2 (13.9-19.1) vs. 5.2 (3.8-9.2)microg/min, P<0.01), blood pressure (136 (123-148)/80 (74-85) vs. 121 (118-124)/72 (70-73) mm Hg, P<0.05), and HbA1 (10.2 (9.1-11.4) vs. 9.0 (8.7-9.4)%, P<0.05) were higher than in those who continued to have persistent normoalbuminuria, retinopathy was more severe and height (1.64 (1.57-1.71) vs. 1.70 (1.69-1.72) m, P<0.05) less. In multivariate analysis, baseline AER was the strongest predictor of the development of persistent microalbuminuria (P<0.0001), followed by mean arterial pressure (P = 0.02) and HbA (P = 0.05).

CONCLUSIONS

The level of AER, raised blood pressure and poor glycaemic control are the most important predictors of the development of microalbuminuria in Type 1 diabetes.

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MeSH

Adolescent
Adult
Albuminuria
Blood Glucose
Blood Pressure
Diabetes Mellitus, Type 1
Diabetic Nephropathies
Diabetic Retinopathy
England
Female
Follow-Up Studies
Glycated Hemoglobin A
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Prospective Studies
Risk Factors
Smoking
Time Factors

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10588521

Citation

"Predictors of the Development of Microalbuminuria in Patients With Type 1 Diabetes Mellitus: a Seven-year Prospective Study. the Microalbuminuria Collaborative Study Group." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 16, no. 11, 1999, pp. 918-25.
Predictors of the development of microalbuminuria in patients with Type 1 diabetes mellitus: a seven-year prospective study. The Microalbuminuria Collaborative Study Group. Diabet Med. 1999;16(11):918-25.
(1999). Predictors of the development of microalbuminuria in patients with Type 1 diabetes mellitus: a seven-year prospective study. The Microalbuminuria Collaborative Study Group. Diabetic Medicine : a Journal of the British Diabetic Association, 16(11), pp. 918-25.
Predictors of the Development of Microalbuminuria in Patients With Type 1 Diabetes Mellitus: a Seven-year Prospective Study. the Microalbuminuria Collaborative Study Group. Diabet Med. 1999;16(11):918-25. PubMed PMID: 10588521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of the development of microalbuminuria in patients with Type 1 diabetes mellitus: a seven-year prospective study. The Microalbuminuria Collaborative Study Group. PY - 1999/12/10/pubmed PY - 1999/12/10/medline PY - 1999/12/10/entrez SP - 918 EP - 25 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 16 IS - 11 N2 - AIMS: To determine risk factors for the development of persistent microalbuminuria (albumin excretion rate (AER) > or =30 microg/min) in Type 1 diabetes mellitus. METHODS: One hundred and forty-eight initially normotensive Type 1 diabetic patients with normal albumin excretion (<30 microg/min) were followed prospectively in hospital diabetes outpatient clinics for a median of 7 years. Main outcome measures were: progression to persistent microalbuminuria (albumin excretion rate > or =30 microg/min on at least two consecutive occasions); rate of change of albumin excretion rate; development of arterial hypertension (systolic blood pressure >160 mm Hg and/or diastolic blood pressure >95 mm Hg or commencement of antihypertensive therapy). RESULTS: In a median follow-up period of 7 years (range 6 months to 8 years), 14 patients progressed to persistent microalbuminuria, a cumulative incidence of 11% (95% confidence interval 6.36-16.94). AER remained persistently <30 microg/min in 109 subjects and 25 developed intermittent microalbuminuria. In those who developed persistent microalbuminuria, baseline AER (16.2 (13.9-19.1) vs. 5.2 (3.8-9.2)microg/min, P<0.01), blood pressure (136 (123-148)/80 (74-85) vs. 121 (118-124)/72 (70-73) mm Hg, P<0.05), and HbA1 (10.2 (9.1-11.4) vs. 9.0 (8.7-9.4)%, P<0.05) were higher than in those who continued to have persistent normoalbuminuria, retinopathy was more severe and height (1.64 (1.57-1.71) vs. 1.70 (1.69-1.72) m, P<0.05) less. In multivariate analysis, baseline AER was the strongest predictor of the development of persistent microalbuminuria (P<0.0001), followed by mean arterial pressure (P = 0.02) and HbA (P = 0.05). CONCLUSIONS: The level of AER, raised blood pressure and poor glycaemic control are the most important predictors of the development of microalbuminuria in Type 1 diabetes. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/10588521/Predictors_of_the_development_of_microalbuminuria_in_patients_with_Type_1_diabetes_mellitus:_a_seven_year_prospective_study__The_Microalbuminuria_Collaborative_Study_Group_ L2 - http://www.diseaseinfosearch.org/result/2236 DB - PRIME DP - Unbound Medicine ER -