A SCREENING-PROGRAM FOR MICROALBUMINURIA AT A DIABETES CLINIC IN APULIA, SOUTHERN ITALY

Microalbuminuria is a predictor of renal and cardiovascular disease in both type 1 (insulin-dependent) and type 2 (insulin-independent) diab etes. We report on a screening programme for microalbuminuria at a dia betes clinic in Italy. All diabetic patients without Albustix-positive proteinuria attending the clinic between April and September 1991 wer e screened. Microalbuminuria was defined as a urinary albumin/creatini ne ratio, on an early morning sterile urine sample, > 3 in at least tw o consecutive urine collections. Three hundred and fifty patients, 45 (20 female, 25 female) type 1 and 305 (145 male, 160 female) type 2 di abetics, were examined. The age range was 18-42 years and 36-73 years and duration of diabetes 1-24 and 1-35 years for type 1 and type 2 dia betic patients respectively. Blood pressure, lipids, glycosylated haem oglobin, body mass index and insulin dose, where appropriate, were mea sured in all patients. Microalbuminuria was found in 8 (22%) of the ty pe 1 diabetics. These patients had a longer duration of diabetes (17.5 vs 7.4 years, P < 0.001), higher diastolic blood pressure (86 +/- 2.1 vs 76 +/- 2.6 mmHg, P < 0.05) and an increased total serum cholestero l level (203 +/- 23 vs 180 +/- 25 mg/dl, P < 0.05) compared with diabe tic patients with microalbuminuria. Of the type 2 diabetic patients 95 (33%) were found to have microalbuminuria and 210 (69%) normoalbuminu ria. The prevalence of hypertension (defined blood pressure > 140/90 m mHg or antihypertensive treatment) and of dyslipidaemia (defined as to tal cholesterol > 200 and triglycerides > 170 or hypolipidaemic treatm ent) were significantly higher (P < 0.001 and 0.01 respectively) in pa tients with microalbuminuria. This study shows a prevalence of microal buminuria in type 1 and type 2 diabetic patients similar to that repor ted in surveys of diabetes clinic outpatients in northern Europe. The association between microalbuminuria and recognized risk factors for c ardiovascular and renal disease justifies screening programmes for mic roalbuminuria for early detection of ''at-risk'' diabetic patients and for the implementation of preventive therapeutic measures.