Advertisement

Diabetologia

, Volume 33, Issue 4, pp 237–243 | Cite as

Microalbuminuria predicts the development of serum lipoprotein abnormalities favouring atherogenesis in newly diagnosed type 2 (non-insulin-dependent) diabetic patients

  • L. Niskanen
  • M. Uusitupa
  • H. Sarlund
  • O. Siitonen
  • E. Voutilainen
  • I. Penttilä
  • K. Pyörälä
Originals

Summary

We studied the relationship of slight albuminuria (microalbuminuria) to serum lipid and lipoproteins in a representative group of middle-aged Type 2 (non-insulin-dependent) diabetic patients. A random sample of non-diabetic control subjects was also examined. Diabetic patients had both at diagnosis and after five years higher total, LDL- and VLDL-triglyceride levels and higher VLDL-cholesterol, but lower HDL-cholesterol levels than non-diabetic subjects. No consistent difference was found in LDL-cholesterol levels between diabetic and non-diabetic subjects. The prevalence of microalbuminuria (>35 mg/24 h) remained about the same in diabetic patients at both examinations (19–20%). The diabetic patients with persistent microalbuminuria were slightly hyperglycaemic and they tended to have lower creatinine clearance at the 5-year examination than those without persistent microalbuminuria. There were no differences in the blood pressure levels or the occurrence of hypertension between the diabetic groups with and without microalbuminuria. At the baseline examination, no differences were seen in serum lipids and lipoproteins between diabetic patients with and without microalbuminuria. In patients with persistent microalbuminuria. a statistically significant increase in VLDL-cholesterol (p<0.05) and VLDL- and LDL-triglyceride levels (p<0.05) and a decrease in HDL-cholesterol level (p<0.05) was seen at the 5-year follow-up. These changes could not be explained by age, sex, body mass index or HbA1. In conclusion, persistent microalbuminuria predicts and aggravates abnormalities in lipoprotein composition and a decrease in HDL-cholesterol in patients with Type 2 diabetes mellitus. The excess cardiovascular morbidity and mortality in diabetic patients with increased albuminuria may, in part, be explained by these lipoprotein abnormalities.

Key words

Microalbuminuria serum lipids lipoproteins Type 2 (non-insulin-dependent) diabetes 

References

  1. 1.
    Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet I: 1430–1432Google Scholar
  2. 2.
    Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 310: 356–360Google Scholar
  3. 3.
    Borch-Johnsen K, Andersen PK, Deckert T (1985) The effect of proteinuria on relative mortality in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 28: 590–596Google Scholar
  4. 4.
    Jarrett RJ, Viberti GC, Argyropoulos A, Hill DR, Mahmud U, Murrells TJ (1984) Microalbuminuria predicts mortality in noninsulin-dependent diabetes. Diabetic Med 1: 17–19Google Scholar
  5. 5.
    Schmitz A, Vaeth M (1988) Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 diabetic patients. Diabetic Med 5: 126–134Google Scholar
  6. 6.
    Nelson RG, Pettitt DJ, Carraher MJ, Baird HR, Knowler WC (1988) Effect of proteinuria on mortality in NIDDM. Diabetes 37: 1499–1504Google Scholar
  7. 7.
    Yudkin JS, Forrest RD, Jackson CA (1988) Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington diabetes survey. Lancet II: 530–533Google Scholar
  8. 8.
    Pyörälä K, Laakso M, Uusitupa M (1987) Diabetes and atherosclerosis: an epidemiologic view. Diab Metab Rev 3: 463–524Google Scholar
  9. 9.
    Mathiesen ER, Oxenbøll B, Johansen K, Svendsen PA, Deckert T (1984) Incipient nephropathy in Type 1 (insulin-dependent) diabetes. Diabetologia 26: 406–410Google Scholar
  10. 10.
    Eckel RH, McLean E, Albers JJ, Cheung MC, Bierman EL (1981) Plasma lipids and microangiopathy in insulin-dependent diabetes mellitus. Diabetes Care 4: 447–453Google Scholar
  11. 11.
    Vannini P, Giavarella A, Flammini M, Bargossi AM, Forlani G, Borgnino LC, Orsoni G (1984) Lipid abnormalities in insulin-dependent diabetic patients with albuminuria. Diabetes Care 7: 151–154Google Scholar
  12. 12.
    Winocour PH, Durrington PN, Ishola M, Anderson DC, Cohen H (1987) Influence of proteinuria on vascular disease, blood pressure, and lipoproteins in insulin dependent diabetes mellitus. Br Med J 294: 1648–1651Google Scholar
  13. 13.
    Jensen T, Stender S, Deckert T (1988) Abnormalities in plasma concentrations of lipoproteins and fibrinogen in Type 1 (insulin-dependent) diabetic patients with increased urinary albumin excretion. Diabetologia 31: 142–145Google Scholar
  14. 14.
    Watts GF, Naumova R, Slavin BM, Morris RW, Houlston R, Kubal C, Shaw KM (1989) Serum lipids and lipoproteins in insulin-dependent diabetic patients with microalbuminuria. Diabetic Med 6: 25–30Google Scholar
  15. 15.
    Jones SL, Close CF, Mattock MB, Jarrett RJ, Keen H, Viberti GC (1989) Plasma lipid and coagulation factor concentrations in insulin dependent diabetics with microalbuminuria. Br Med J 298: 487–490Google Scholar
  16. 16.
    Keen H (1987) Macrovascular disease in diabetes mellitus. In: Andreani D, Crepaldi G, Di Mario U, Pozza G (eds) Diabetic complications: early diagnosis and treatment. Vol 1. Wiley, Chichester New York Brisbane Toronto Singapore, PP 3–12Google Scholar
  17. 17.
    Mattock MB, Keen H, Viberti GC, El-Gohari MR, Murrells TJ, Scott GS, Wing JR, Jackson PG (1988) Coronary heart disease and urinary albumin excretion rate in Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 31: 82–87Google Scholar
  18. 18.
    Uusitupa M, Siitonen O, Aro A, Pyörälä K (1985) Prevalence of coronary heart disease, left ventricular failure and hypertension in middle-aged, newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects. Diabetologia 28: 22–27Google Scholar
  19. 19.
    WHO Expert Committee (1980) Second report on diabetes mellitus. Geneva, World Health Organization. (Technical Report Series 646)Google Scholar
  20. 20.
    Korhonen T, Uusitupa M, Aro A, Kumpulainen T, Siitonen O, Voutilainen E, Pyörälä K (1987) Efficacy of dietary instructions in newly diagnosed non-insulin-dependent diabetic patients. Comparison of two different patient education regimens. Acta Med Scand 222: 323–331Google Scholar
  21. 21.
    Uusitupa M, Siitonen O, Penttilä I, Aro A, Pyörälä K (1987) Proteinuria in newly diagnosed type II diabetic patients. Diabetes Care 10: 191–194Google Scholar
  22. 22.
    Penttilä IM, Voutilainen E, Laitinen P, Juutilainen P (1981) Comparison of three different analytical and precipitation methods for the direct estimation of serum high-density lipoprotein cholesterol. Scand J Chem Lab Invest 41: 353–360Google Scholar
  23. 23.
    Uusitupa M, Siitonen O, Voutilainen E, Aro A, Hersio K, Pyörälä K, Penttilä I, Ehnholm C (1986) Serum lipids and lipoproteins in newly diagnosed non-insulin-dependent (type 2) diabetic patients, with special reference to factors influencing HDL-cholesterol and triglyceride levels. Diabetes Care 9: 17–22Google Scholar
  24. 24.
    Fabre J, Balant LP, Dayer PG, Fox HM, Verner AT (1982) The kidney in maturity-onset diabetes mellitus: a clinical study of 510 patients. Kidney Int 21: 730–738Google Scholar
  25. 25.
    Mogensen CE, Christensen CK, Vittinghus E (1983) The stages in diabetic renal disease with emphasis on the stage of incipient diabetic nephropathy. Diabetes 32 (Suppl 2): 64–78Google Scholar
  26. 26.
    Kostner GM, Karadi I (1988) Lipoprotein alterations in diabetes mellitus. Diabetologia 31: 717–722Google Scholar
  27. 27.
    Betteridge DJ (1989) Diabetes, lipoprotein metabolism and atherosclerosis. Br Med Bull 45: 285–311Google Scholar
  28. 28.
    Chan MK, Persaud JW, Ramdial L, Varghese Z, Sweny P, Moorhead JF (1981) Hyperlipidaemia in untreated nephrotic syndrome, increased production or decreased removal? Clin Chim Acta 117: 317–323Google Scholar
  29. 29.
    Mohamed A, Wilkin T, Leatherdale BA, Rawe D (1984) Response of urinary albumin to submaximal exercise in newly diagnosed non-insulin-dependent diabetes. Br Med J 1: 1342–1343Google Scholar
  30. 30.
    Vasquez B, Flock EV, Savage PJ, Nagulesparan M, Bennion LJ, Baird HR, Bennett PH (1984) Sustained reduction of proteinuria in Type 2 (non-insulin-dependent) diabetes following diet-induced reduction of hyperglycaemia. Diabetologia 26: 127–133Google Scholar
  31. 31.
    Jerums G, Cooper ME, Seeman E, Murray RML, McNeil JJ (1987) Spectrum of proteinuria in type I and type II diabetes. Diabetes Care 10: 419–427Google Scholar
  32. 32.
    Uusitupa M, Niskanen L, Siitonen O, Voutilainen E, Pyörälä K (1990) 5-year incidence of atherosclerotic vascular diseases in relation to general risk factors, insulin level and lipoprotein abnormalities in non-insulin-dependent diabetic and non-diabetic subjects. Circulation (in press)Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • L. Niskanen
    • 1
  • M. Uusitupa
    • 2
  • H. Sarlund
    • 1
  • O. Siitonen
    • 1
  • E. Voutilainen
    • 1
  • I. Penttilä
    • 3
  • K. Pyörälä
    • 1
  1. 1.Department of MedicineKuopio University Central HospitalKuopioFinland
  2. 2.Department of Clinical NutritionKuopio University Central HospitalKuopioFinland
  3. 3.Department of Clinical ChemistryKuopio University Central HospitalKuopioFinland

Personalised recommendations