URINARY ALBUMIN EXCRETION AS A PREDICTOR OF DIABETIC-RETINOPATHY, NEUROPATHY, AND CARDIOVASCULAR-DISEASE IN NIDDM

OBJECTIVE - The relationship between urinary albumin excretion (UAE) a nd diabetic complications in NIDDM has not been studied in a large Ame rican population. The demonstrated relationship between increased UAE and the development of retinopathy, nephropathy, and neuropathy in IDD M makes this an important issue to also be studied in NIDDM patients. RESEARCH DESIGN AND METHODS - A large population study of 947 NIDDM pa tients living predominantly in a metropolitan area was undertaken. Thr ee categories of UAE, namely, normal albuminuria (<20 mu g/min), micro albuminuria (20-200 mu g/min), and overt albuminuria (>200 mu g/min) w ere compared with 1) retinopathy as assessed by stereoscopic fundus ph otographs; 2) cardiovascular disease as assessed by a history of cardi ac disease or stroke; ischemic changes on exercise treadmill testing; Q wave myocardial infarction; Estes, Sokolow, or Cornell criteria for left ventricular hypertrophy; positive Rose questionnaire for angina; and an abnormal Doppler exam for peripheral vascular disease; and 3) n europathy as assessed by neurological symptom and disability scores, a utonomic function testing, and quantitative sensory exams involving th ermal and vibratory sensation. Selected patient characteristics were t hen evaluated to determine their effects on the presence of diabetic c omplications using univariate analyses. Multiple logistic regression a nalyses were then performed to determine the independent effect of UAE on these diabetic complications. RESULTS - chi 2 analyses revealed th at UAE was significantly associated with the presence of retinopathy ( P < 0.001), neuropathy (P < 0.001), and cardiovascular disease (P < 0. 001). In the multiple logistic regression analyses, UAE had strong ind ependent associations with retinopathy, neuropathy, and cardiovascular disease. CONCLUSIONS - Thus, increasing UAE in this large NIDDM popul ation in the U.S. was associated with an increased prevalence of diabe tic retinopathy, neuropathy, and cardiovascular disease. This suggests that UAE may be more than an indicator of renal disease in NIDDM pati ents and, in fact, may reflect a state of generalized vascular damage occurring throughout the body. Prospective studies in NIDDM patients a re needed to determine the predictive effect of UAE and the effect of decreasing UAE on future diabetic micro- and macrovascular complicatio ns.