CLINICAL CORRELATES WITH MICROALBUMINURIA IN NON-INSULIN-DEPENDENT DIABETES - PRELIMINARY-RESULTS OF THE APPROPRIATE BLOOD-PRESSURE CONTROLIN DIABETES TRIAL

Clinical correlates associated with urinary albumin excretion (UAE) in non-insulin dependent diabetes (NIDDM) are less well known than in in sulin dependent diabetes (IDDM). We therefore performed a cross sectio nal study examining the relationships of clinical risk factors and dia betic complications with UAE in 950 NIDDM patients. The UAE status was classified into the following categories: (i) no albuminuria (<20 mu mg/min), (ii) microalbuminuria (20-200 mu g/min); and (iii) overt albu minuria (>200 mu g/min). iu Univariate and miltivariate analyses were initially performed evaluating the associations between clinical risk factors and UAE. Univariate and multivariate analyses were then perfor med examining the relationships between UAE and the diabetic complicat ions (retinopathy, neuropathy and cardiovascular disease). Using multi variate logistic regression analyses controlling for diabetes duration , glycosylated haemoglobin, gender and race, the most significant pred ictors of microalbuminuria and overt albuminuria were systolic hyperte nsion, increased body mass index (BMI), decreased high-density lipopro tein (HDL) cholesterol, insulin use and smoking pack years. Univariate and multivariate analyses evaluating the associations between UAE and diabetic complications revealed that UAE was a strong predictor of re tinopathy (odds ratio [OR]=1.31:95% confidence interval [CI]=1.05,1.66 ), neuropathy (OR=1.47; CI=1.19,19.83), and cardiovascular diseases (O R=1.28; CI=1.05,1.52). Thus, in the present study increases in UAE wer e associated with retinopathy, neuropathy and cardiovascular disease. Urinary albumin excretion may therefore be a marker of diffuse vascula r disease in NIDDM. Aggressive treatment of smoking, cholesterol and h ypertension may not only diminish UAE but may also play a significant role in decreasing the other NIDDM vascular complications.