title: Progression to microalbuminuria in patients with type 1 diabetes: a seven-year prospective study.
abstract: BACKGROUND
  The presence of microalbuminuria can be associated with overt nephropathy and cardiovascular disease in patients with type 1 diabetes (T1D). We aimed to determine the incidence and evaluate the baseline predictors for the development of microalbuminuria in patients with T1D.
  
  
  METHODS
  This study is a longitudinal cohort study of 122 normoalbuminuric patients with T1D who were receiving routine clinical care at baseline. A detailed medical history was taken, and a physical examination was performed at baseline. All of the patients were regularly examined for diabetes-associated complications. An analysis of predictors was performed using the Cox regression.
  
  
  RESULTS
  Over 6.81 (3.59-9.75) years of follow-up, 50 (41%) of the patients developed microalbuminuria. The incidence density was 6.79/100 people per year (95% CI 5.04-8.95), and the microalbuminuria developed after 5.9 (2.44-7.76) and 11 (5-15) years of follow-up and diabetes duration, respectively. After an individual Cox regression, the baseline variables associated with the development of microalbuminuria were age, age at diagnosis, duration of diabetes, systolic and diastolic blood pressure, fasting glycemia, body mass index (BMI), total cholesterol and triglycerides levels, cholesterol/HDL ratio and a family history of type 2 diabetes.After a multivariate Cox regression, the only independent factors associated with the development of microalbuminuria were BMI [HR 1.12 (1.03-1.21)] and cholesterol/HDL ratio [HR 1.32 (1.05-1.67)].
  
  
  CONCLUSIONS
  A higher BMI and cholesterol/HDL ratio increased the risk of developing microalbuminuria in young patients with T1D after a short follow-up. Both risk factors are modifiable and should be identified early and followed closely.
authors.affiliation: Division of Diabetes, Department of Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil. robertacobas@ig.com.br.
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Cobas
authors.forename: Bráulio
authors.initials: B
authors.lastname: Santos
authors.forename: Pedro Cb
authors.initials: PC
authors.lastname: da Silva
authors.forename: Ricardo
authors.initials: R
authors.lastname: Neves
authors.forename: Marilia B
authors.initials: MB
authors.lastname: Gomes