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Microalbuminuria in type 1 diabetes: rates, risk factors and glycemic threshold
N Chaturvedi1, S Bandinelli, R Mangili
1EURODIAB, University College London, London, England, United Kingdom. n.chaturvedi@ic.ac.uk
Background:
The occurrence of microalbuminuria in type 1 diabetes is strongly predictive of renal and cardiovascular disease and is still likely to occur despite improvements in glycemic control. A better understanding of microalbuminuria is required to inform new interventions. We determined the incidence and risk factors for microalbuminuria [albumin excretion rate (AER) 20 to 200 microg/min] in the EURODIAB Prospective Complications Study.
Methods:
This is a seven-year follow-up (between 1988 and 1991) of 1134 normoalbuminuric men and women (aged 15 to 60) with type 1 diabetes from 31 European centers. Risk factors and AER were measured centrally.
Results:
The incidence of microalbuminuria was 12.6% over 7.3 years. Independent baseline risk factors were HbA1c (7.1 vs. 6.2%, P = 0.0001) and AER (9.6 vs. 7.8 microg/min, P = 0.0001) and, independent of these, fasting triglyceride (0.99 vs. 0.88 mmol/L, P = 0.01), low-density lipoprotein cholesterol (3.5 vs. 3.2 mmol/L, P = 0.02), body mass index (24.0 vs. 23.4 kg/m2, P = 0.01), and waist to hip ratio (WHR; 0.85 vs. 0.83, P = 0.009). Triglyceride and WHR risk factors were nearly as strong as AER in predicting microalbuminuria (standardized regression effects of 1.3 for triglyceride and WHR and 1.5 for AER). Blood pressure at follow-up, but not at baseline, was also raised in those who progressed. There was no evidence of a threshold of HbA1c on microalbuminuria risk.
Conclusions:
The incidence of microalbuminuria in patients with type 1 diabetes remains high, and there is no apparent glycemic threshold for it. Markers of insulin resistance, such as triglyceride and WHR, are strong risk factors. Systemic blood pressure is not raised prior to the onset of microalbuminuria.
Insights
Microalbuminuria incidence in type 1 diabetes remains high. Insulin resistance markers like triglyceride and waist-to-hip ratio are key risk factors, independent of glycemic control.
Area of Science:
- Endocrinology
- Nephrology
- Diabetology
Background:
- Microalbuminuria in type 1 diabetes predicts renal and cardiovascular disease.
- Understanding microalbuminuria is crucial for developing new interventions.
- The EURODIAB Prospective Complications Study investigated microalbuminuria incidence and risk factors.
Purpose of the Study:
- To determine the incidence of microalbuminuria (albumin excretion rate [AER] 20 to 200 microg/min) in type 1 diabetes.
- To identify baseline risk factors for microalbuminuria.
- To explore the relationship between glycemic control, insulin resistance markers, and microalbuminuria.
Main Methods:
- Seven-year follow-up of 1134 normoalbuminuric individuals with type 1 diabetes.
- Data collected from 31 European centers.
- Centralized measurement of risk factors and albumin excretion rate (AER).
Main Results:
- Microalbuminuria incidence was 12.6% over 7.3 years.
- Independent baseline risk factors included HbA1c, AER, fasting triglyceride, LDL cholesterol, BMI, and waist-to-hip ratio (WHR).
- Triglyceride and WHR were strong predictors, comparable to AER; elevated blood pressure was observed at follow-up, not at baseline.
Conclusions:
- Microalbuminuria incidence in type 1 diabetes is high, with no clear glycemic threshold.
- Insulin resistance markers (triglyceride, WHR) are significant risk factors.
- Systemic blood pressure is not elevated before microalbuminuria onset.