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Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study.
Nephrol Dial Transplant. 2008 Apr; 23(4):1278-84.ND

Abstract

BACKGROUND

We evaluated to what extent the presence of risk factors and their interactions increased the likelihood of microalbuminuria (MAU) among individuals with type 2 diabetes.

METHODS

Fifty-five Italian diabetes outpatient clinics enrolled a sample of patients with type 2 diabetes, without urinary infections and overt diabetic nephropathy. A morning spot urine sample was collected to centrally determine the urinary albumin/creatinine ratio (ACR). A tree-based regression technique (RECPAM) and multivariate analyses were performed to investigate interaction between correlates of MAU.

RESULTS

Of the 1841 patients recruited, 228 (12.4%) were excluded due to the presence of urinary infections and 56 (3.5%) for the presence of macroalbuminuria. Overall, the prevalence of MAU (ACR = 30-299 mg/g) was of 19.1%. The RECPAM algorithm led to the identification of seven classes showing a marked difference in the likelihood of MAU. Non-smoker patients with HbA1c <7% and waist circumference </=102 cm showed the lowest prevalence of MAU (7.5%), and represented the reference class. Patients with retinopathy, waist circumference >98 cm and HbA1c >8% showed the highest likelihood of MAU (odds ratio = 13.7; 95% confidence intervals 6.8-27.6). In the other classes identified, the risk of MAU ranged between 3 and 5. Age, systolic blood pressure, HDL cholesterol levels and diabetes treatment represented additional, global correlates of MAU.

CONCLUSIONS

The likelihood of MAU is strongly related to the interaction between diabetes severity, smoking habits and several components of the metabolic syndrome. In particular, abdominal obesity, elevated blood pressure levels and low HDL cholesterol levels substantially increase the risk of MAU. It is of primary importance to monitor MAU in high-risk individuals and aggressively intervene on modifiable risk factors.

Authors+Show Affiliations

Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

18039647

Citation

Rossi, Maria C E., et al. "Identifying Patients With Type 2 Diabetes at High Risk of Microalbuminuria: Results of the DEMAND (Developing Education On Microalbuminuria for Awareness of reNal and Cardiovascular Risk in Diabetes) Study." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 23, no. 4, 2008, pp. 1278-84.
Rossi MC, Nicolucci A, Pellegrini F, et al. Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study. Nephrol Dial Transplant. 2008;23(4):1278-84.
Rossi, M. C., Nicolucci, A., Pellegrini, F., Comaschi, M., Ceriello, A., Cucinotta, D., Giorda, C., Valentini, U., Vespasiani, G., & De Cosmo, S. (2008). Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 23(4), 1278-84.
Rossi MC, et al. Identifying Patients With Type 2 Diabetes at High Risk of Microalbuminuria: Results of the DEMAND (Developing Education On Microalbuminuria for Awareness of reNal and Cardiovascular Risk in Diabetes) Study. Nephrol Dial Transplant. 2008;23(4):1278-84. PubMed PMID: 18039647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study. AU - Rossi,Maria C E, AU - Nicolucci,Antonio, AU - Pellegrini,Fabio, AU - Comaschi,Marco, AU - Ceriello,Antonio, AU - Cucinotta,Domenico, AU - Giorda,Carlo, AU - Valentini,Umberto, AU - Vespasiani,Giacomo, AU - De Cosmo,Salvatore, Y1 - 2007/11/26/ PY - 2007/11/28/pubmed PY - 2008/5/2/medline PY - 2007/11/28/entrez SP - 1278 EP - 84 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 23 IS - 4 N2 - BACKGROUND: We evaluated to what extent the presence of risk factors and their interactions increased the likelihood of microalbuminuria (MAU) among individuals with type 2 diabetes. METHODS: Fifty-five Italian diabetes outpatient clinics enrolled a sample of patients with type 2 diabetes, without urinary infections and overt diabetic nephropathy. A morning spot urine sample was collected to centrally determine the urinary albumin/creatinine ratio (ACR). A tree-based regression technique (RECPAM) and multivariate analyses were performed to investigate interaction between correlates of MAU. RESULTS: Of the 1841 patients recruited, 228 (12.4%) were excluded due to the presence of urinary infections and 56 (3.5%) for the presence of macroalbuminuria. Overall, the prevalence of MAU (ACR = 30-299 mg/g) was of 19.1%. The RECPAM algorithm led to the identification of seven classes showing a marked difference in the likelihood of MAU. Non-smoker patients with HbA1c <7% and waist circumference </=102 cm showed the lowest prevalence of MAU (7.5%), and represented the reference class. Patients with retinopathy, waist circumference >98 cm and HbA1c >8% showed the highest likelihood of MAU (odds ratio = 13.7; 95% confidence intervals 6.8-27.6). In the other classes identified, the risk of MAU ranged between 3 and 5. Age, systolic blood pressure, HDL cholesterol levels and diabetes treatment represented additional, global correlates of MAU. CONCLUSIONS: The likelihood of MAU is strongly related to the interaction between diabetes severity, smoking habits and several components of the metabolic syndrome. In particular, abdominal obesity, elevated blood pressure levels and low HDL cholesterol levels substantially increase the risk of MAU. It is of primary importance to monitor MAU in high-risk individuals and aggressively intervene on modifiable risk factors. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/18039647/Identifying_patients_with_type_2_diabetes_at_high_risk_of_microalbuminuria:_results_of_the_DEMAND__Developing_Education_on_Microalbuminuria_for_Awareness_of_reNal_and_cardiovascular_risk_in_Diabetes__Study_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfm798 DB - PRIME DP - Unbound Medicine ER -