Microalbuminuria in diabetic patients: relationship to lipid, glyco-metabolic, coagulation and fibrinolysis parameters.
One hundred and sixteen insulin treated diabetic patients were evaluated for the relationship between the presence of microalbuminuria and several lipid, glyco-metabolic, coagulation and fibrinolysis factors. A significant correlation existed only between microalbuminuria and HbA1c (r = 0.23, p = 0.008) and D-dimer (r = 0.28, p = 0.002). After the subdivision of the patients in a group without (n = 85) and a group with microalbuminuria (n = 31) significant differences were found between these two groups for the HDL-cholesterol content (p less than 0.05), the HbA1c level (p less than 0.01) and for the D-dimer concentration (p less than 0.01). Comparison of the patient groups without and with microalbuminuria separately with a healthy volunteers group without albuminuria resulted in significant differences for HDL-cholesterol, triacylglycerols, HbA1c, fructosamine, fibrin monomer and D-dimer, whereas fibrinogen also was significantly different between the diabetic group without microalbuminuria and the healthy volunteers group. Several factors predisposing for atherosclerosis (decrease of HDL-cholesterol, increase of triacylglycerols, coagulation activation with relatively insufficient fibrinolysis) were noticed in both diabetic groups without or with microalbuminuria, but more pronounced in the latter group. The appliance of a Receiver Operating Characteristic (ROC) curve for HbA1c against microalbuminuria (cut-off level 20 micrograms/min) reconfirmed the value of adequate glycaemic control in diabetics for the prevention of microalbuminuria. In conclusion the results of this study show a significantly poorer glycaemic control in insulin treated diabetics with microalbuminuria than in those without microalbuminuria. The presence of lower HDL-cholesterol, higher triacylglycerols and the elevation of fibrin monomers and D-dimers is more pronounced in the microalbuminuria group.(ABSTRACT TRUNCATED AT 250 WORDS)
van Wersch
J W
JW
Haematological laboratory, St. Gregorius Hospital, Brunssum, The Netherlands.
Donders
S H
SH
Westerhuis
L W
LW
Venekamp
W J
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000097:blood*; D001777:Blood Coagulation; D002784:Cholesterol / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis; D005260:Female; D005342:Fibrinolysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
D002784:Cholesterol; D006442:Glycated Hemoglobin; D008074:Lipoproteins