PREDICTORS OF MORTALITY IN INSULIN-DEPENDENT DIABETES - 10-YEAR OBSERVATIONAL FOLLOW-UP-STUDY

Citation
P. Rossing et al., PREDICTORS OF MORTALITY IN INSULIN-DEPENDENT DIABETES - 10-YEAR OBSERVATIONAL FOLLOW-UP-STUDY, BMJ. British medical journal, 313(7060), 1996, pp. 779-784
Citations number
39
Categorie Soggetti
Medicine, General & Internal
ISSN journal
09598138
Volume
313
Issue
7060
Year of publication
1996
Pages
779 - 784
Database
ISI
SICI code
0959-8138(1996)313:7060<779:POMIID>2.0.ZU;2-Q
Abstract
Objective-To evaluate the prognostic significance of microalbuminuria and overt diabetic nephropathy and other putative risk factors for car diovascular and all cause mortality in insulin dependent diabetes. Des ign-Ten year observational follow up study. Setting-Outpatient diabeti c clinic in a tertiary referral centre. Subjects-All 939 adults with i nsulin dependent diabetes (duration of diabetes five years or more) at tending the clinic in 1984; 593 had normal urinary albumin excretion ( less than or equal to 30 mg/24 h), 181 persistent microalbuminuria (31 -299 mg/24 h), and 165 overt nephropathy (greater than or equal to 300 mg/24 h). Main outcome measure-All cause and cardiovascular mortality . Results-Fifteen per cent of patients (90/593) with normoalbuminuria, 25% (45/181) with microalbuminuria, and 44% (72/165) with overt nephr opathy at baseline died during follow up. Cox multiple regression anal ysis identified the following significant predictors of all cause mort ality: male sex (relative risk 2.03; 95% confidence interval 1.37 to 3 .02), age (1.07; 1.06 to 1.08), height (0.96; 0.94 to 0.98), smoking ( 1.51; 1.09 to 2.08), social class V versus social class IV (1.70; 1.25 to 2.31), log(10) urinary albumin excretion (1.45; 1.18 to 1.77), hyp ertension (1.63; 1.18 to 2.25), log(10) serum creatinine concentration (8.96; 3.34 to 24.08), and haemoglobin A(1c) concentration (1.11; 1.0 3 to 1.20). Age, smoking, microalbuminuria, overt nephropathy, and hyp ertension were significant predictors of cardiovascular mortality. Mor tality in patients with microalbuminuria was only slightly increased c ompared with that in patients with normoalbuminuria. Median survival t ime after the onset of overt diabetic nephropathy was 13.9 years (95% confidence interval 11.8 to 17.2 years). Conclusions-Abnormally increa sed urinary albumin excretion and other potentially modifiable risk fa ctors such as hypertension, smoking, poor glycaemic control, and socia l class predict increased mortality in insulin dependent diabetes. Mic roalbuminuria by itself confers only a small increase in mortality. Th e prognosis of patients with overt diabetic nephropathy has improved, probably owing to effective antihypertensive treatment.