Renal involvement in type 1 (IDDM) diabetes in Spain. ESTUDIO DIAMANTE.

Diabetic nephropathy (DN) is a major complication of diabetes with a significant repercussion in health care with few epidemiological data available in Spain. The aim of this multicenter cross-sectional study was to establish the prevalence of renal involvement in a large group of patients with type 1 (insulin-dependent) diabetes and evaluate several risk factors related to its development. One thousand eight hundred twenty-two patients (921 males, mean age: 30.5 +/- 9.7 years, diabetes duration 14.1 +/- 9.2 years) from the Endocrinology Units of 18 Spanish hospitals were included in this study. Urinary albumin excretion (UAE), plasma creatinine, lipid profile, HbA1c, and family history of hypertension and nephropathy, smoking, arterial blood pressure and BMI were evaluated. The prevalence of microalbuminuria, established nephropathy (patients with macroalbuminuria and those with renal failure) and hypertension was 14.1, 8.5 and 11.3%, respectively. On logistic regression analysis, using the presence or absence of established nephropathy as variable, smoking (P = 0.0005), years of diabetes evolution (P < 0.00005), diastolic blood pressure (P < 0.00005), HbA1c (P < 0.00005) and triglycerides (P = 0.0008) were included in the model. When analyzing patients with microalbuminuria vs those with normoalbuminuria the variables included were smoking (P = 0.005), diastolic blood pressure (P = 0.0026), years of diabetes evolution (P < 0.00005) and HbA1c (P < 0.00005). prevalence of diabetic nephropathy DN in type 1 (insulin-dependent) diabetes in Spain is similar to that observed ther European countries. The association between diabetic nephropathy DN and hypertension, lipid disorders and metabolic control is confirmed and smoking appears to be an additional risk factor to be considered in diabetic care.