Is increasing urinary albumin a better marker for microvascular than for macrovascular complication of type 2 diabetes mellitus?
OBJECTIVE
The aims of the study were to evaluate the prevalence of increased urinary albumin excretion (UAE) and associated cardiovascular risk factors and vascular diabetes complications in patients with type 2 diabetes mellitus (DM).


METHODS
We studied 975 patients in a cross-sectional design from 1998 to 2000. Frequency of micro- and macroalbuminuria, and their associations with cardiovascular risk factors and vascular DM complications, were examined.


RESULTS
Prevalence of increased UAE was 28.5% (18.3% micro- and 10.2% macroalbuminuria). Body mass index (BMI) (only females) and hemoglobin (Hb)A1c significantly correlated with macroalbuminuria (p = 0.034, p = 0.027, respectively), while high blood pressure (diastolic) was associated with microalbuminuria (p = 0.008). Diabetes duration, high systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides were significantly correlated with both micro- and macroalbuminuria. Increased UAE was associated with neuropathy (relative risk (RR) 2.12, confidence interval (CI) 1.07-4.19), retinopathy (RR 2.19, CI 1.76-2.74) and hypertension (RR 2.91, CI 1.77-4.78), but not with cardiovascular disease, high cholesterol and peripheral vascular disease. In the multiple logistic regression analysis, a significant association of albuminuria was found with diabetes duration (odds ratio (OR) 1.59, CI 0.98-2.58; p < 0062), hypertension (OR 3.42, CI 2.22-5.27; p < 0.0001), low HDL cholesterol (OR 1.78, CI 1.31-2.43; p < 0.0003), current smoking status (OR 2.19, CI 1.32-3.64; p < 0.0024), and increased serum creatinine (OR 11.16, CI 5.7-21.7; p < 0.0001).


CONCLUSIONS
Prevalence of increased UAE was similar to that described in other geographically close populations. The stronger association found with microvascular diabetes complications suggests that increased UAE is a better predictor for renal damage than for cardiovascular disease in this type 2 DM population.
Herrera-Pombo
Jose L
JL
Jiménez Díaz Foundation, Autónoma University, Madrid, Spain. jherrera@fjd.es
Aguilar-Diosdado
Manuel
M
Hawkins
Federico
F
Campos
Maria M
MM
Moreno
Alberto
A
Garcia-Hernandez
Alberto
A
Castro
Elda
E
García-Doncel
Lourdes G
LG
Serraclara
Alicia
A
Sánchez-Malo
Carolina
C
Escobar-Jiménez
Fernando
F
D000419:Albuminuria / Q000209:etiology*; D015415:Biomarkers; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000652:urine; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000652:urine*; D003928:Diabetic Nephropathies / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis
D015415:Biomarkers