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Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38070.450891.FE (Published 06 May 2004) Cite this as: BMJ 2004;328:1105
  1. Peter Hovind (phovind{at}dadlnet.dk), medical doctor1,
  2. Lise Tarnow, medical doctor1,
  3. Peter Rossing, medical doctor1,
  4. Malene Graae, consultant nurse1,
  5. Inge Torp, laboratory technician1,
  6. Christian Binder, chief physician1,
  7. Hans-Henrik Parving, professor1
  1. 1Steno Diabetes Center, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark
  1. Correspondence to: P Hovind
  • Accepted 5 March 2004

Abstract

ObjectiveTo evaluate baseline predictors for the development of persistent microalbuminuria and macroalbuminuria prospectively in patients with type 1 diabetes.

DesignProspective observational study of an inception cohort.

SettingOutpatient diabetic clinic in a tertiary referral centre, Gentofte, Denmark.

Participants286 patients (216 adults) newly diagnosed with type 1 diabetes consecutively admitted to the clinic between 1 September 1979 and 31 August 1984.

Main outcome measuresPersistent microalbuminuria and persistent macroalbuminuria.

ResultsDuring the median follow up of 18.0 years (range 1.0-21.5 years), total of 4706 patient years of follow up, 79 of 277 (29%) patients developed persistent microalbuminuria. 27 of 79 progressed further to persistent macroalbuminuria. The cumulative incidence of persistent microalbuminuria and persistent macroalbuminuria was 33.6% (95% confidence interval 27.2% to 40.0%) and 14.6% (8.9% to 20.3%), respectively. Significant predictors for the development of persistent microalbuminuria were a 10-fold increase in urinary albumin excretion rate (relative risk 3.78, 1.57 to 9.13), being male (2.41, 1.43 to 4.06), a 10 mm Hg increase in mean arterial blood pressure (1.38, 1.20 to 1.57), a 1% increase in haemoglobin A1c(1.18, 1.04 to 1.32), and a 1 cm increase in height (0.96, 0.95 to 0.98). 28 patients with microalbuminuria (35%) regressed to normoalbuminuria either transiently (n = 15) or permanently (n = 13).

ConclusionsAround one third of patients newly diagnosed with type 1 diabetes develop persistent microalbuminuria within the first 20 years of diabetes. Several potentially modifiable risk factors predict the development of persistent microalbuminaria and persistent macroalbuminuria.

Footnotes

  • Contributors PH assessed and evaluated the patients during the last five years of follow up, planned and carried out the data analyses, and drafted the paper. LT, PR, BRJ, IT, MG, and CB reviewed the paper. LT assessed and evaluated the patients during the last 10 years of follow up. PR supervised the data analyses. BRJ participated in data collection and supervised data collection and laboratory analyses for the last 10 years. IT participated in data collection and supervised data collection and laboratory analyses until 1994. MG participated in data collection and the care and the follow up of the patients. CB designed the study, supervised all phases of the study including patient treatment and evaluation until 1994. H-HP supervised all phases of the study for the last 10 years, including patient treatment and evaluation, and supervised the writing of the paper. PH and H-HP will act as guarantors for the paper.

  • Funding This study was funded by the Danish Diabetes Association, the Paul and Erna Sehested Hansen Foundation, the Aase and Ejnar Danielsen Foundation, and the Per S Henriksen Foundation.

  • Conflict of interest CB holds stocks in Novo Nordisk, which makes products related to the treatment of diabetes, and is a paid consultant by the same company for clinical quality assurance and quality improvement in diabetes care.

  • Ethical approval This study was approved by the local ethics committee in Copenhagen.

  • Accepted 5 March 2004
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