Division of Diabetes, Department of Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Diabetol Metab Syndr. 2011 Aug 26;3:21. doi: 10.1186/1758-5996-3-21.
The presence of microalbuminuria can be associated with overt nephropathy and cardiovascular disease in patients with type 1 diabetes (T1D). We aimed to determine the incidence and evaluate the baseline predictors for the development of microalbuminuria in patients with T1D.
This study is a longitudinal cohort study of 122 normoalbuminuric patients with T1D who were receiving routine clinical care at baseline. A detailed medical history was taken, and a physical examination was performed at baseline. All of the patients were regularly examined for diabetes-associated complications. An analysis of predictors was performed using the Cox regression.
Over 6.81 (3.59-9.75) years of follow-up, 50 (41%) of the patients developed microalbuminuria. The incidence density was 6.79/100 people per year (95% CI 5.04-8.95), and the microalbuminuria developed after 5.9 (2.44-7.76) and 11 (5-15) years of follow-up and diabetes duration, respectively. After an individual Cox regression, the baseline variables associated with the development of microalbuminuria were age, age at diagnosis, duration of diabetes, systolic and diastolic blood pressure, fasting glycemia, body mass index (BMI), total cholesterol and triglycerides levels, cholesterol/HDL ratio and a family history of type 2 diabetes.After a multivariate Cox regression, the only independent factors associated with the development of microalbuminuria were BMI [HR 1.12 (1.03-1.21)] and cholesterol/HDL ratio [HR 1.32 (1.05-1.67)].
A higher BMI and cholesterol/HDL ratio increased the risk of developing microalbuminuria in young patients with T1D after a short follow-up. Both risk factors are modifiable and should be identified early and followed closely.
1 型糖尿病（T1D）患者微量白蛋白尿的存在可能与显性肾病和心血管疾病有关。我们旨在确定 T1D 患者微量白蛋白尿的发生率，并评估其发生的基线预测因素。
本研究是对 122 例基线时接受常规临床护理的 T1D 患者进行的一项纵向队列研究。在基线时，我们详细询问了病史并进行了体格检查。所有患者均定期检查糖尿病相关并发症。使用 Cox 回归进行预测因素分析。
在 6.81 年（3.59-9.75 年）的随访期间，有 50 名（41%）患者发生了微量白蛋白尿。发病率密度为 6.79/100 人/年（95%CI 5.04-8.95），微量白蛋白尿分别在随访 5.9 年（2.44-7.76 年）和 11 年（5-15 年）后出现。经过个体 Cox 回归分析，与微量白蛋白尿发生相关的基线变量为年龄、诊断年龄、糖尿病病程、收缩压和舒张压、空腹血糖、体重指数（BMI）、总胆固醇和甘油三酯水平、胆固醇/高密度脂蛋白比值和 2 型糖尿病家族史。经过多变量 Cox 回归分析，与微量白蛋白尿发生相关的独立因素为 BMI [HR 1.12（1.03-1.21）]和胆固醇/高密度脂蛋白比值 [HR 1.32（1.05-1.67）]。
在短期随访后，BMI 和胆固醇/高密度脂蛋白比值较高的 T1D 年轻患者发生微量白蛋白尿的风险增加。这两个危险因素都是可以改变的，应及早识别并密切随访。
