title: Factors Associated With Serum Albumin in Diabetes Mellitus Type 2 With Microalbuminuria Using Non-Normal Mixed Models: A Prospective Cohort Study.
abstract: BACKGROUND
  The globally increasing epidemic of diabetes will lead to serious problems including diabetic nephropathy and kidney diseases in near future. The first clinical diagnosable stage in a diabetic kidney disease is microalbuminuria (urinary albumin excretion of 30 - 300 g/24 hours).
  
  
  OBJECTIVE
  This prospective cohort study investigated the risk factors of microalbuminuria in patients with type 2 diabetes who had been registered in endocrine and metabolism research center in Isfahan city, Iran.
  
  
  METHODS
  This prospective cohort study was performed on 90 diabetic type 2 patients with microalbuminuria, who were selected according to the consecutive sample selection method during 6 years. Data were collected through regular and systematic measurements of serum albumin as the response variable and body mass index, systolic and diastolic blood pressure, the duration of diabetes, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride (TG), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) as the related factors. Non-normal mixed models were used to investigate the impact of effective factors on the amount of excreted serum albumin.
  
  
  RESULTS
  According to the deviance information criterion (DIC = 56.2), the non-normal mixed effects model with the skewed t distribution had a best fit and indicated that HbA1c, HDL and total cholesterol had a significant effect on the amount of albumin in urine (P < 0.05).
  
  
  CONCLUSIONS
  Using nonnormal mixed models may lead to the best results as compared to common normality assumption.
authors.affiliation: Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran.
authors.forename: Batoul
authors.initials: B
authors.lastname: Khoundabi
authors.affiliation: Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran.
authors.forename: Anoshirvan
authors.initials: A
authors.lastname: Kazemnejad
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Marjan
authors.initials: M
authors.lastname: Mansourian
authors.affiliation: Department of Internal Medicine, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Faghihimani
keywords: Diabetes Mellitus Type 2; Risk Factors; Serum Albumin