Microalbuminuria in insulin dependent diabetes mellitus

This study aimed to evaluate the prevalence of microalbuminuria (MAU) and albumin excretion rate (AER) in a timed overnight (12 hours) urine sample, in 72 insulin-dependent-diabetic (IDD) patients and to correlate the same to the clinical profile, glycemic control and to diabetic complications. Nine IDD patients (prevalence--12.5%) were detected to be microalbuminuric. Males had significantly higher prevalence of MAU (17.4%) than females (3.8%; p < 0.05). The prevalence of MAU was 4% in the third decade of age, 15% each in the fourth and fifth and 28.6% and 60% in the sixth decade and above (p < 0.05%). Prevalence of MAU also increased progressively with duration of diabetes. It increased from 8.3% (< 5 yrs) to 12.5% (6-10 yrs) and 33.3% (> 15 yrs). High AER in obese patients--33.1 +/- 23.2 v/s 11.4 +/- 3.4 micrograms/min in lean patients supports an association of obesity with albuminuria. Higher prevalences of MAU (62.5%; p < 0.001) was observed in hypertensive IDD patients in comparison to normotensive patients (3.6%). AER in patients with borderline hypertension (21.0 +/- 14.5 micrograms/min; p < 0.05) and in overt hypertensives (49.1 +/- 19.2 micrograms/min; p < 0.0005) were significantly higher compared to normotensive IDD-patients (6.2 +/- 2.4 micrograms/min). Prevalence of MAU and AER increased progressively with the deterioration of glycemic control. Well controlled subjects were normoalbuminuric. The incidence of MAU increased from 11.1% in fairly controlled (NS) and 21.1% in poorly controlled (p < 0.01) subjects. Also AER increased significantly from 2.4 +/- 0.5 micrograms/min. to 9.8 +/- 6.7 and 23.1 +/- 7.3 micrograms/min with the deterioration of glycemic control. Glycemic control in terms of glycated hemoglobin (GHb) did not show much agreement with the prevalence of MAU and AER, though they worsened with deteriorating control. The prevalences of peripheral neuropathy (PN) (34.4% v/s 33.3%) and diabetic retinopathy (DR) (9.8% v/s 11.1%) were similar in normo- and microalbuminuric patients. Patients with PN had high AER (15.2 +/- 6.3 micrograms/min). Also, AER was significantly high in patients with DR (27.7 +/- 23.5 micrograms/min; p < 0.05). High prevalences of cardio-vascular disease (CVD) (33.3%; p < 0.05) were observed in microalbuminuric compared to normoalbuminuric (1.6%) patients. Also AER was significantly high in association with CVD (53.9 +/- 21.9 micrograms/min; p < 0.0005). It can be concluded that, in IDD patients, MAU is common in males, older individuals and subjects with longer duration of diabetes. Raised blood pressure and hyperglycemia were identified as risk factors for the development of MAU.