Abstract
Microalbuminuria is the earliest sign of diabetic nephropathy, and is a marker of increased diabetic cardiovascular morbidity and mortality. We investigated the prevalence of albuminuria and associated risk factors among Type 2 diabetes (T2DM) patients, who were attending diabetes clinics at primary healthcare facilities in Bahrain. This was a cross-sectional study on 712 adult T2DM Bahraini patients screened for albuminuria using albumin:creatinine ratio test (ACR), in 9 selected primary healthcare centers in Bahrain in the period February–March 2006. Of the 702 participants, 196 (27.9%) were albuminuric. The prevalence of microalbuminuria (ACR>3.4 mg albumin/mmol creatinine) and macroalbuminuria (protein:creatinine ratio >22 mg protein/mmol creatinine) were 22.0% (no.=155) and 5.8% (no.=41), respectively. Univariate analysis demonstrated significant associations between albuminuria and older age (>65 yr), longer duration of diabetes, high glycated hemoglobin (HbA1c), elevated triglycerides, total- and LDL-cholesterol, systolic (>160 mmHg) and diastolic (>90 mmHg) blood pressure (BP), and retinopathy. Multivariate regression analysis showed that high HbA1c, higher systolic BP, and long duration of diabetes, were significant predictors of albuminuria, while older age, male gender, and higher triglycerides were borderline predictors. Albuminuria in Bahraini T2DM patients was related to poor glycemic control, higher systolic BP, and longer duration of diabetes. Effective preventive and control strategies of those factors should be urgently implemented.
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References
Al-Zurba F. Latest studies clarify state of health in Bahrain. Diabetes Voice 2001, 46: 28–31.
Al-Mahroos F, McKeigue PM. High prevalence of diabetes in Bahrainis. Associations with ethnicity and raised plasma cholesterol. Diabetes Care 1998, 21: 936–42.
Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med 1993, 328: 1676–85.
McIntosh A, Hutchinson A, Marshall S, et al. Clinical Guidelines and Evidence Review for Type 2 Diabetes, Renal Disease: Prevention and Early Management. Sheffield: ScHARR, University of Sheffield, 2002.
Wu AY, Kong NC, de Leon FA, et al. An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 2005, 48: 17–26.
Gerstein HC, Mann JF, Yi Q, et al; HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001, 286: 421–6.
Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 2005, 28: 164–76.
Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature. Arch Int Med 1997, 157: 1413–8.
Miettinen H, Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Proteinuria predicts stroke and other atherosclerotic vascular disease events in nondiabetic and non-insulin-dependent diabetic subjects. Stroke 1996, 27: 2033–9.
Kramer MS. Clinical Epidemiology and Biostatistics: A Primer for Clinical Investigators and Decision-Makers. 1st ed. Berlin, Germany: Springer-Verlag, 1988.
Ahmedani MY, Hydrie MZ, Iqbal A, Gul A, Mirza WB, Basit A. Prevalence of microalbuminuria in type 2 diabetic patients in Karachi: Pakistan: a multi-center study. J Pak Med Assoc 2005, 55: 382–6.
Al-Futaisi A, Al-Zakwani I, Almahrezi A, et al. Prevalence and predictors of microalbuminuria in patients with type 2 diabetes mellitus: a cross-sectional observational study in Oman. Diab Res Clin Prac 2006, 72: 212–5.
Buranakitjaroen P, Deerochanawong C, Bunnag P. Microalbuminuria prevalence study (MAPS) in hypertensive patients with type 2 diabetes in Thailand. J Med Assoc Thailand 2005, 88: 1624–9.
Varghese A, Deepa R, Rema M, Mohan V. Prevalence of microalbuminuria in type 2 diabetes mellitus at a diabetes centre in southern India. Postgrad Med J 2001, 77: 399–402.
Modebe O, Masoomi MA. Microalbuminuria and associated factors in Bahraini patients with type 2 diabetes mellitus. Ann Saudi Med 2000, 20: 157–60.
Salman R. Evaluation of diabetes service provision in a government health centre in Bahrain. Bahrain Med Bull 2005, 27: 3–12.
Al Khaja KA, Sequeira R, Damanhori AH. Evaluation of drug therapy and risk factors in diabetic hypertensives: a study of the quality of care provided in diabetic clinics in Bahrain. J Eval Clin Pract 2005, 11: 121–31.
American Diabetes Association. Standards of medical care in diabetes — 2006. Diabetes Care 2006, 29(Suppl 1): S4–42.
Lepore G, Maglio ML, Nosari I, Dodesini AR, Trevisan R. Cost-effectiveness of two screening programs for microalbuminuria in type 2 diabetes. Diabetes Care 2002, 25: 2103–4.
Myers GL, Miller WG, Coresh J, et al; National Kidney Disease Education Program Laboratory Working Group. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 2006, 52: 5–18.
World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: World Health Organization, 1999.
Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289: 2560–72.
Williams B, Poulter NR, Brown MJ, et al; British Hypertension Society. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004, 18: 139–85.
Krentz AJ, Bailey CJ. Type 2 Diabetes in Practice, 1st ed. London: Royal Society of Medicine Press, 2001.
Kirkwood BR, Stern AC. Essential Medical Statistics. 2nd ed, London: Blackwell Science Ltd, 2003.
Cederholm J, Eliasson B, Nilsson PM, Weiss L, Gudbjornsdottir S. Microalbuminuria and risk factors in type 1 and type 2 diabetic patients. Diab Res Clin Pract 2005, 67: 258–66.
Haffner SM, Morales PA, Gruber MK, Hazuda HP, Stern MP. Cardiovascular risk factors in non-insulin-dependent diabetic subjects with microalbuminuria. Arterioscl Thromb 1993, 13: 205–10.
Collins VR, Dowse GK, Finch CF, Zimmet PZ, Linnane AW. Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru. Diabetes 1989, 38: 1602–10.
Hamman RF, Franklin GA, Mayer EJ, et al. Microvascular complications of NIDDM in Hispanicsand non-Hispanic whites. San Luis Valley Diabetes Study. Diabetes Care 1991, 14: 655–64.
Gall MA, Hougaard P, Borch-Johnsen K, Parving HH. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. BMJ 1997, 314: 783–8.
Sasaki A, Horiuchi N, Hasegawa K, Uehara M. 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 1989, 7: 299–306.
Song K-H, Yoon K-H, Kang M-I, et al. Progression to overt proteinuria in microalbuminuric Koreans with non-insulin-dependent diabetes mellitus. Diab Res Clin Pract 1998, 42: 117–21.
Mogensen CE. Microalbuminuria and hypertension with focus on type 1 and type 2 diabetes. J Intern Med 2003, 254: 45–66.
Knudsen ST, Poulsen PL, Hansen KW, Ebbehoj E, Bek T, Mogensen CE. Pulse pressure and diurnal blood pressure variation: association with micro- and macrovascular complications in type 2 diabetes. Am J Hypertens 2002, 15: 244–50.
Davis TM, Stratton IM, Fox CJ, Holman RR, Turner RC. U.K. Prospective Diabetes Study 22. Effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM. Diabetes Care 1997, 20: 1435–41.
Wirta OR, Pasternack AI, Mustonen JT, Koivula TA, Harmoinen A. Urinary albumin excretion rate and its determinants after 6 years in non-insulin-dependent diabetic patients. Nephrol Dial Transplant 1996, 11: 449–56.
Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Arch Intern Med 1998, 158: 998–1004.
Martínez MA, Moreno A, Aguirre de Cárcer A, et al; MAPA3-Madrid Working Group. Frequency and determinants of microalbuminuria in mild hypertension: a primary-care-based study. J Hypertens 2001, 19: 319–26.
Festa A, D’Agostino R, Howard G, Mykkanen L, Tracy RP, Haffner SM. Inflammation and microalbuminuria in nondiabetic and type 2 diabetic subjects: The Insulin Resistance Atherosclerosis Study. Kidney Int 2000, 58: 1703–10.
Gerstein HC, Mann JF, Pogue J, et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care 2000, 23(Suppl 2): B35–9.
Mattock MB, Barnes DJ, Viberti G, et al. Microalbuminuria and coronary heart disease in NIDDM: an incidence study. Diabetes 1998, 47: 1786–92.
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Al-Salman, R.A., Al-Basri, H.A., Al-Sayyad, A.S. et al. Prevalence and risk factors of albuminuria in Type 2 diabetes in Bahrain. J Endocrinol Invest 32, 746–751 (2009). https://doi.org/10.1007/BF03346530
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DOI: https://doi.org/10.1007/BF03346530