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Diabetologia

, Volume 34, Issue 9, pp 655–661 | Cite as

Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European Type 2 (non-insulin-dependent) diabetic patients

  • M. -A. Gall
  • P. Rossing
  • P. Skøtt
  • P. Damsbo
  • A. Vaag
  • K. Bech
  • A. Dejgaard
  • M. Lauritzen
  • E. Lauritzen
  • P. Hougaard
  • H. Beck-Nielsen
  • H. H. Parving
Originals

Summary

The prevalence of micro- and macroalbuminuria was determined in Type 2 (non-insulin-dependent) diabetic patients, less than 76 years of age, attending a diabetic clinic during 1987. All eligible patients (n=557) were asked to collect a 24-h urine sample for quantitative albumin analysis. Urine collections were obtained in 296 males and 253 females (96%). Normoalbuminuria were defined as urinary albumin excretion≤30 mg/24 h (n=323), microalbuminuria as 31–299 mg/24 h (n=151), and macroalbuminuria as ≥300 mg/ 24 h (n=75). The prevalence of macroalbuminuria was significantly higher in males (20%) than in females (6%), while the prevalence of microalbuminuria was almost identical in males (26%) and females (29%). The prevalence of arterial hypertension increased with increased albuminuria, being 48%, 68%, and 85% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of proliferative retinopathy rose with increasing albuminuria, being 2%, 5% and 12% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of coronary heart disease, based on Minnesota coded electrocardiograms, was more frequent in patients with macroalbuminuria (46%) compared to patients with microalbuminuria (26%) and patients with normoalbuminuria (22%). Foot ulcers were more frequent in micro- and macroalbuminuric patients, being 13% and 25%, respectively, compared to 5% in patients with normoalbuminuria. This cross-sectional study has revealed a high prevalence of microalbuminuria (27%) and macroalbuminuria (14%) in Type 2 diabetic patients. Patients with raised urinary albumin excretion are characterized by obesity, elevated haemoglobin Alc, increased frequency of arterial hypertension, proliferative retinopathy, coronary heart disease and foot ulcers. Thus, these findings suggest that urinary excretion of albumin should be monitored routinely in patients with Type 2 diabetes.

Key words

Type 2 (non-insulin-dependent) diabetes mellitus microalbuminuria macroalbuminuria arterial hypertension retinopathy macroangiopathy 

References

  1. 1.
    Sasaki A, Horiuchi N, Hasegawa K, Uehara M (1986) Risk factors related to the development of persistent albuminuria among diabetic patients observed in a long-term follow-up. J Jpn Diabetes Soc 29: 1017–1023Google Scholar
  2. 2.
    Kunzelman CL, Pettitt DJ, Bennett PH, Knowler WC (1985) Incidence of nephropathy in Type 2 diabetes mellitus. Am J Epidemiol 122: 547–548Google Scholar
  3. 3.
    Ballard DJ, Humphrey LL, Joseph Melton III I, Frohnert PP, Chu C, O'Fallon WM, Palumbo PJ (1988) Epidemiology of persistent proteinuria in Type II diabetes mellitus. Population-based study in Rochester, Minnesota. Diabetes 37: 405–412PubMedGoogle Scholar
  4. 4.
    Eggers PW (1988) Effect of transplantation on the medicare endstage renal disease program. N Engl J Med 318: 223–229PubMedGoogle Scholar
  5. 5.
    Rettig B, Teutsch SM (1984) The incidence of end-stage renal disease in Type I and Type II diabetes mellitus. Diab Nephropath 3: 26–27Google Scholar
  6. 6.
    Grenfell A, Bewick M, Parsons V, Snowden S, Taube D, Watkins PJ (1988) Non-insulin-dependent diabetes and renal replacement therapy. Diab Med 5: 172–176Google Scholar
  7. 7.
    Nelson RG, Pettitt DJ, Carraher MJ, Robert Baird H, Knowler WC (1988) Effect of proteinuria on mortality in NIDDM. Diabetes 37: 1499–1504PubMedGoogle Scholar
  8. 8.
    Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 310: 356–360PubMedGoogle Scholar
  9. 9.
    Schmitz A, Vaeth M (1988) Microalbuminuria: a major risk factor in Type 2 Diabetes. A 10-year follow-up study of 503 patients. Diab Med 5: 126–134Google Scholar
  10. 10.
    Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ (1984) Microalbuminuria predicts mortality in noninsulin-dependent diabetes. Diab Med 1: 17–19Google Scholar
  11. 11.
    Hother-Nielsen O, Faber O, Sørensen NS, Beck-Nielsen H (1988) Classification of newly diagnosed diabetic patients as insulin-requiring or non-insulin-requiring based on clinical and biochemical variables. Diab Care 11: 531–537Google Scholar
  12. 12.
    Faber OK, Binder C (1977) C-peptide response to glucagon: a test for the residual β-cell function in diabetes mellitus. Diabetes 26: 605–610PubMedGoogle Scholar
  13. 13.
    Rose G, Blackburn H, Gillum RF, Prineas RJ (1982) Cardiovascular survey methods. WHO Monograph Series No 56, Geneva, pp 162–165Google Scholar
  14. 14.
    Blackburn H, Keys A, Simonsen E, Rautaharju P, Punsar S (1960) The electrocardiogram in population studies: a classification system. Circulation 21: 1160–1175PubMedGoogle Scholar
  15. 15.
    Christensen C, Ørskov C (1984) Rapid screening PEG radioimmunoassay for quantitation of pathological microalbuminuria. Diab Nephropath 3: 92–94Google Scholar
  16. 16.
    Mogensen CE, Chachati A, Christensen CK et al. (1986) Microalbuminuria: an early marker of renal involvement in diabetes. Uremia Invest 9: 85–95Google Scholar
  17. 17.
    Mortensen HB (1980) Quantitative determination of hemoglobin Alc by thinlayer isoelectric focusing. J Chromatogr 182: 325–333PubMedGoogle Scholar
  18. 18.
    Ullmann R, Bonitz K (1976) Vollmechanisierte kinetische Messung von Kreatinin. Med Labor Bd 29: 137–145Google Scholar
  19. 19.
    Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Nat Cancer Inst 27: 719–748Google Scholar
  20. 20.
    Agresti A (1984) Analysis of ordinal categorical data. Wiley, New YorkGoogle Scholar
  21. 21.
    Klein R, Klein BEK, Moss S, DeMets DL (1988) Proteinuria in diabetes. Arch Intern Med 148: 181–186PubMedGoogle Scholar
  22. 22.
    Damsgaard EM, Mogensen CE (1986) Microalbuminuria in elderly hyperglycaemic patients and controls. Diab Med 3: 430–435Google Scholar
  23. 23.
    Nelson RG, Kunzelman CL, Pettitt DJ, Saad MF, Bennett PH, Knowler WC (1989) Albuminuria in Type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians. Diabetologia 32: 870–876CrossRefPubMedGoogle Scholar
  24. 24.
    Knowler WC, Kunzelman CL (1988) Population comparison of the frequency of diabetic nephropathy. In: Mogensen CE (ed) The kidney and hypertension in diabetes mellitus. Nijhoff, Boston, pp 25–32Google Scholar
  25. 25.
    Haffner SM, Mitchell BD, Pugh JA et al. (1989) Proteinuria in Mexican Americans and non-hispanic whites with NIDDM. Diab Care 12: 530–536Google Scholar
  26. 26.
    Samanta A, Burden AC, Feehally J, Walls J (1986) Diabetic renal disease: differences between Asian and white patients. Br Med J 293: 366–367Google Scholar
  27. 27.
    Marshall SM, Alberti KGMM (1989) Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent diabetes. Quart J Med 261: 61–71Google Scholar
  28. 28.
    Parving H-H, Gall M-A, Skøtt P, Jørgensen HE, Jørgensen F, Larsen S (1990) Prevalence and causes of albuminuria in non-insulin-dependent diabetic (NIDDM) patients. Kidney Int 37: 243 AbstractGoogle Scholar
  29. 29.
    Sasaki A, Horiuchi N, Hasagawa K, Uehara M (1989) Persistent albuminuria as an index of diabetic nephropathy in type 2 diabetic patients in Osaka, Japan — incidence, risk factors, prognosis and causes of death. Diab Res Clin Pract 7: 299–306CrossRefGoogle Scholar
  30. 30.
    Knowler WC, Bennett PH, Nelson RG (1988) Prediabetic blood pressure predicts albuminuria after development of NIDDM. Diabetes 37 [Suppl]: 120 AbstractGoogle Scholar
  31. 31.
    Berkman J, Rifkin H (1973) Unilateral nodular diabetic glomerulosclerosis (Kimmelstiel-Wilson). Report of a case. Metabolism 22: 715–722CrossRefPubMedGoogle Scholar
  32. 32.
    Beroniade VC, Lefebvre R, Falardeau P (1987) Unilateral nodular diabetic glomerulosclerosis: recurrence of an experiment of nature. Am J Nephrol 7: 55–59PubMedGoogle Scholar
  33. 33.
    Pettitt DJ, Knowler WC, Lisse JR, Bennett PH (1980) Development of retinopathy and proteinuria in relation to plasma-glucose concentrations in Pima Indians. Lancet II: 1050–1052CrossRefGoogle Scholar
  34. 34.
    Feldt-Rasmussen B, Mathiesen ER, Deckert T (1986) Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes. Lancet II: 1300–1304CrossRefGoogle Scholar
  35. 35.
    Dahl-Jørgensen K, Brinchmann-Hansen O, Hansen KF et al. (1986) Effect of near-normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy and neuropathy: the Oslo Study. Br Med J 293: 1195–1199Google Scholar
  36. 36.
    Parving H-H, Hommel E, Mathiesen E et al. (1988) Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J 296: 156–160Google Scholar
  37. 37.
    Damsgaard EM, Frø1and A, Jørgensen OD, Mogensen CE (1990) Microalbuminuria as predictor of increased mortality in elderly people. Br Med J 300: 297–300Google Scholar
  38. 38.
    Yudkin JS, Forrest RD, Jackson CA (1988) Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington Diabetes Survey. Lancet I: 530–533CrossRefGoogle Scholar
  39. 39.
    Mattock MB, Keen H, Viberti GC et al. (1988) Coronary heart disease and urinary albumin excretion rate in Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 31: 82–87PubMedGoogle Scholar
  40. 40.
    Allawi J, Jarrett RJ (1990) Microalbuminuria and cardiovascular risk factors in Type 2 diabetes mellitus. Diab Med 7: 115–118Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • M. -A. Gall
    • 1
  • P. Rossing
    • 1
  • P. Skøtt
    • 1
  • P. Damsbo
    • 1
  • A. Vaag
    • 1
  • K. Bech
    • 1
  • A. Dejgaard
    • 1
  • M. Lauritzen
    • 1
  • E. Lauritzen
    • 1
  • P. Hougaard
    • 2
  • H. Beck-Nielsen
    • 1
  • H. H. Parving
    • 1
  1. 1.Hvidöre HospitalKlampenborg
  2. 2.Novo Research InstituteBagsvaerdDenmark

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