Albuminuria and poor glycemic control predict mortality in NIDDM.
The impact of microalbuminuria and macroalbuminuria on mortality was evaluated prospectively in 328 Caucasian patients with non-insulin-dependent diabetes mellitus (NIDDM) followed for 5 years. One hundred ninety-one (109 men and 82 women) patients with normoalbuminuria (albumin excretion rate [AER] < 30 mg/24 h), 86 (50 men and 36 women) patients with microalbuminuria (AER 30-299 mg/24 h), and 51 (43 men and 8 women) patients with macroalbuminuria (AER > or = 300 mg/24 h) < 66 years old at entry were followed from 1987 until death or until 1 January 1993. Mean age at entry was 54 (SD 9) years. In January 1993, 8% of patients with normoalbuminuria, 20% of patients with microalbuminuria, and 35% of patients with macroalbuminuria had died (predominantly from cardiovascular disease) (P < 0.01 [normoalbuminuria versus micro- and macroalbuminuria] and P < 0.05 [microalbuminuria versus macroalbuminuria]). Cox multiple regression analysis revealed significant predictors of all-cause mortality to be preexisting coronary heart disease (relative risk [95% confidence interval]), 2.9 (1.6-5.1); log10AER (factor 10), 1.9 (1.4-2.6); HbA1c level (%), 1.2 (1.0-1.4); and age (years), 1.08 (1.03-1.13). Significant predictors of cardiovascular mortality included preexisting coronary heart disease, 6.1 (2.8-13.5); macroalbuminuria, 2.5 (1.1-5.8); HbA1c level (%), 1.3 (1.1-1.6); and systolic blood pressure (10 mmHg), 1.2 (1.0-1.4). Univariate Cox survival analysis in the normoalbuminuric group revealed that AER above the median of 8 mg/24 h was associated with an increased all-cause mortality risk of 2.7 (0.93-7.69) (P = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)
Gall
M A
MA
Steno Diabetes Center, Gentofte, Denmark.
Borch-Johnsen
K
K
Hougaard
P
P
Nielsen
F S
FS
Parving
H H
HH
D000368:Aged; D000419:Albuminuria; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000401:mortality* / Q000652:urine; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
D015415:Biomarkers; D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin