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Predictors of the development of microalbuminuria in patients with type I diabetes mellitus: A seven-year prospective study

Lookup NU author(s): Emerita Professor Sally Marshall


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Aims: To determine risk factors for the development of persistent microalbuminuria (albumin excretion rate (AER)≥30μg/min) in Type 1 diabetes mellitus. Methods: One hundred and forty-eight initially normotensive Type 1 diabetic patients with normal albumin excretion (<30μg/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 ≥ 30 μg/min on at least two consecutive occasions); rate of change of albumin excretion rate; development of arterial hypertension (systolic blood pressure >160mmHg and/or diastolic blood pressure > 95 mmHg 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 μg/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)μg/min, P<0.01), blood pressure (136 (123148)/80 (74-85) vs. 121 (118-124)/72 (70-73) mmHg, 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 HbA1 (P = 0.05). Conclusions: The level of AER, raised blood pressure and poor giycaemic control are the most important predictors of the development of microalbuminuria in Type 1 diabetes.

Publication metadata

Author(s): Close CF, Collins A, Gregory W, Goodwin A, Hill C, Jarrett RJ, Jones SL, Keen H, Scott GS, Viberti G, Vora H, Yip J, Grenfell A, Sampson MJ, Watkins PJ, Fishwick C, Gatling W, Hill RD, Marshall SM, Coates P, Owens DR, Peters JR, Vora J, Warren S

Publication type: Article

Publication status: Published

Journal: Diabetic Medicine

Year: 1999

Volume: 16

Issue: 11

Pages: 918-925

Print publication date: 01/11/1999

ISSN (print): 0742-3071

ISSN (electronic): 1464-5491

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1046/j.1464-5491.1999.00182.x

PubMed id: 10588521

Notes: The authors belonged to The Microalbuminuria Collaborative Study Group.


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