INCREASED URINARY ALBUMIN EXCRETION IS ASSOCIATED WITH A CLUSTER OF METABOLIC ALTERATIONS IN TYPE-2 DIABETES-MELLITUS

The relationship between urinary albumin excretion rate (UAE) and some metabolic and haemodynamic characteristics was studied in 62 (50 male , 12 female) type 2 (non-insulin-dependent) diabetic patients, with (2 6 male, 5 female) and without (24 male, 7 female) ischaemic heart dise ase (IHD), free from overt diabetic nephropathy. The overall populatio n was subdivided into quartiles on the basis of UAE values (mg/24 h): group 1 (16 subjects), 3.3-7 (range); group 2 (15 subjects), 7.22-11.8 ; group 3 (15 subjects), 11.9-30; group 4 (16 microalbuminuric subject s), 31.7-226. The groups were comparable with regard to age, duration of diabetes and prevalence of smokers. From group 1 to group 4 we foun d increasing levels of body mass index (BMI) (24.2+/-0.6, 26.6+/-0.7, 27.6+/-0.7, 27.6+/-0.9 kg/m2; P = 0.007), HbA1c (5.99+/-0.2, 6.45+/-0. 35, 7.02+/-0.41, 7.4+/-0.39%; P = 0.017), total cholesterol (5.30+/-0. 26, 5.51+/-0.34, 6.14+/-0.21, 6.32+/-0.26 mmol/l; P = 0.026), triglyce rides (1.37+/-0.20, 1.67+/-0.21, 2.07+/-0.29, 2.55+/-0.45 mmol/l; P = 0.034) and prevalence of hypertension (50%, 67%, 67%, 81%; P = 0.088). No significant differences were found between C-peptide, insulin resi stance (K index of insulin tolerance test) and high-density lipoprotei n (HDL)-cholesterol levels. Groups 1 + 2 had a lower prevalence of IHD in comparison with groups 3 + 4 (42% vs 58%, P = 0.069). Using multip le regression analysis, only HbA1c was independently associated with l og10 UAE in the overall population (P = 0.002), including as independe nt variables age, duration of diabetes, BMI, total cholesterol, trigly cerides and mean arterial pressure. In conclusion: (1) type 2 diabetic patients show higher BMI, HbA1c, total cholesterol, triglyceride leve ls and prevalence of hypertension with increasing UAE, even in the nor moalbuminuric range; (2) the prevalence of IHD is higher in the groups with elevated UAE; (3) glycaemic control is the only metabolic charac teristic independently associated with UAE.