MICROALBUMINURIA DEVELOPMENT IN SHORT-TERM IDDM

To assess risk factors associated with microalbuminuria development in short-term evolution insulin-dependent diabetes mellitus (IDDM) we un dertake a cross-sectional study with retrospective examination of the 34 patients diagnosed with IDDM between 1982 and 1983 and followed up for at least 7 years in an outpatient endocrinology clinic. Main measu res: (1) At IDDM diagnosis: age, sex, parameters of metabolic control (fasting glycemia, HbA(1)), islet-cell antibodies, insulin autoantibod ies, endogenous insulin secretion (EIS) and HLA type. (2) At 1 year ev olution: EIS re-evaluation. (3) From IDDM diagnosis (every 3-4 month): body mass index, insulin schedule and dose, and parameters of metabol ic control. (4) At 7-year evolution: 24-h urinary albumin excretion (U AE) and arterial blood pressure measurements on two consecutive outpat ient controls. Microalbuminuria was defined as UAE above 30 mu g/min o n the two consecutive measurements. After 7-year follow-up, 8 (23.5%; 95% Cl: 9.3 to 37.7%) patients developed microalbuminuria. Their metab olic control was worse (7 years mean HbA(1): 10.7 vs. 9.7%; P = 0.04) and 1 year EIS lower (1.9 vs. 7.6 ng/ml. 10 min; P = 0.03) than in nor moalbuminuric patients. They also had higher prevalence of 'high-norma l' arterial blood pressure (P = 0.03) and diabetic retinopathy (P = 0. 01) than normoalbuminuric patients did. Stepwise logistic regression a nalysis showed that diabetic retinopathy was the only independent and significant risk factor related to microalbuminuria development (P = 0 .01). We conclude that in subjects with short-term evolution IDDM, mic roalbuminuria development was associated with glycemic control, EIS an d arterial blood pressure levels, however the strongest association wa s found with diabetic retinopathy occurrence.