Morbidity, mortality, and albuminuria in type 2 diabetic patients: a three-year prospective study of a random cohort in general practice.
In a 3-year prospective study, the prevalence of albuminuria and its relationship to macrovascular disease, pre-existing vascular risk factors and mortality rate were studied in a random cohort of 290 patients with Type 2 diabetes mellitus in general practice. Newly occurring micro- or macroalbuminuria was associated with significantly (p less than 0.05) higher systolic blood pressure: median (IQ range) 157 (140-170) vs 150 (130-160) mmHg, in addition to higher serum triglycerides: median (IQ range) 2.71 (1.84-4.25) vs 1.84 (1.35-3.14) mmol l-1, and C-peptide levels: median (IQ range) 1.30 (0.98-2.16) vs 1.10 (0.82-1.58) nmol l-1, at 3-year follow-up. Patients with macroalbuminuria at final examination had significantly higher systolic and diastolic blood pressure, serum triglyceride and beta 2-microglobulin levels, decreased HDL-cholesterol, and a significantly higher prevalence of carotid artery stenoses and peripheral vascular disease. Patients dying from vascular causes showed significantly higher urinary albumin levels at entrance as compared to the surviving patients: median (IQ range): 42.2 (11-249.7) vs 10.4 (4.6-28.0) mg l-1, p less than 0.008, and overall mortality rate was significantly linked with the presence of macroalbuminuria (26% vs 5% in normoalbuminuric patients). A comparison between the results of the initial and the final examination indicated an overall worsening of renal variables (albuminuria: median (IQ range): female 9.5 (4.5-21) vs 13.4 (5.1-39.7) mg l-1, (p less than 0.05); male 13.8 (4.7-34.1) vs 32.6 (8.1-78.7) (p less than 0.001), despite a significant improvement in metabolic variables.(ABSTRACT TRUNCATED AT 250 WORDS)
Stiegler
H
H
Third Medical Department, City Hospital Schwabing, Munich, Germany.
Standl
E
E
Schulz
K
K
Roth
R
R
Lehmacher
W
W
D000367:Age Factors; D000368:Aged; D000419:Albuminuria; D001794:Blood Pressure; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D005194:Family Practice; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D011897:Random Allocation; D012307:Risk Factors; D012727:Sex Characteristics