title: Cardiovascular risk factors and incident albuminuria in screen-detected type 2 diabetes.
abstract: It is unclear whether cardiovascular risk factor modification influences the development of renal disease in people with type 2 diabetes identified through screening. We determined predictors of albuminuria 5 years after a diagnosis of screen-detected diabetes within the ADDITION-Europe study, a pragmatic cardiovascular outcome trial of multifactorial cardiovascular risk management.
  
  
  
  In 1826 participants with newly diagnosed, screen-detected diabetes without albuminuria, we explored associations between risk of new albuminuria (≥2.5 mg mmol-1for males and ≥3.5 mg mmol-1for females) and (1) baseline cardio-metabolic risk factors and (2) changes from baseline to 1 year in systolic blood pressure (ΔSBP) and glycated haemoglobin (ΔHbA1c) using logistic regression.
  
  
  
  Albuminuria developed in 268 (15%) participants; baseline body mass index and active smoking were independently associated with new onset albuminuria in 5 years after detection of diabetes. In a model adjusted for age, gender, baseline HbA1cand blood pressure, a 1% decrease in HbA1cand 5-mm Hg decrease in SBP during the first year were independently associated with lower risks of albuminuria (odds ratio), 95% confidence interval: 0.76, 0.62 to 0.91 and 0.94, 0.88 to 1.01, respectively. Further adjustment did not materially change these estimates. There was no interaction between ΔSBP and ΔHbA1cin relation to albuminuria risk, suggesting likely additive effects on renal microvascular disease.
  
  
  
  Baseline measurements and changes in HbA1cand SBP a year after diagnosis of diabetes through screening independently associate with new onset albuminuria 4 years later. Established multifactorial treatment for diabetes applies to cases identified through screening.
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: D R
authors.initials: DR
authors.lastname: Webb
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: F
authors.initials: F
authors.lastname: Zaccardi
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.|Primary Care Unit, Cambridge Institute of Public Health, Cambridge, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Griffin
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: R K
authors.initials: RK
authors.lastname: Simmons
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: G E
authors.initials: GE
authors.lastname: Rutten
authors.affiliation: School of Public Health, Section of General Practice, University of Aarhus, Aarhus, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Sandbaek
authors.affiliation: School of Public Health, Section of General Practice, University of Aarhus, Aarhus, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Lauritzen
authors.affiliation: Holbaek Hospital, Holbaek, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Borch-Johnsen
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin
keywords: ADDITION-Europe; albuminuria; microvascular complications; screening; systolic blood pressure; type 2 diabetes