INITIAL URINARY ALBUMIN EXCRETION DETERMINES THE PROGRESSION OF MICROALBUMINURIA IN PATIENTS WITH TYPE-2 DIABETES AND NORMOTENSIVE BLOOD-PRESSURE VALUES DESPITE IMPROVED METABOLIC CONTROL

Persistent increased urinary albumin excretion rate (UAER) is associat ed with increased cardiovascular mortality in type-2 diabetes, however , there are no conclusive data about the progression of advanced UAER in these patients. The present study has investigated the effect of me tabolic intervention on the progression in UAER in relation to initial UAER levels. A total of 20 patients with type-2 diabetes and secondar y failure to sulfonylurea were observed during 1 year (age, 60 +/- 8 y ears; HbA(1c), 10.8 +/- 1.4%; and duration of diabetes, 17 +/- 10 year s) and divided into two groups: group 1 (n = 10; UAER: 51 +/- 35 mg/24 h); and group 2 (n = 10; UAER: 191 +/- 175 mg/24 h). Despite a signif icant improvement of metabolic control by insulin treatment in both gr oups (HbA(1c): groupl: 11 +/- 1.5 vs. 7.9 +/- 1.2%; group 2: 10.6 +/- 0.9 vs. 9.1 +/- 1.3%, P<0.001), a progression of UAER was observed in group 2 (191 +/- 175 vs. 331 +/- 237 mg/24 h, P < 0.02), but not in gr oup 1 (51 +/- 35 vs. 41 +/- 24 mg/24 h). Still serum creatinine levels remained normal in all patients during the observation period. The 24 h blood pressure (RR) values in the two groups remained normal under antihypertensive therapy throughout the study (group 1: RR syst: 130 v s. 136 mmHg; RR diast: 80 vs. 81 mmHg, mean arterial pressure (MAD): 8 9 vs. 93 mmHg; group 2: RR syst: 139 vs. 134 mmHg; RR diast: 78 vs. 75 mmHg, MAD: 97 vs. 90 mmHg). The data shows that in type-2 diabetic pa tients with normotensive blood pressure values the initial urinary alb umin excretion levels determine the progression of UAER. When metaboli c control is improved incipient UAER remains constant, but advanced UA ER shows progression. (C) 1998 Elsevier Science Ireland Ltd. All right s reserved.