Morbidity, Mortality, and Albuminuria in Type 2 Diabetic Patients: a Three‐year Prospective Study of a Random Cohort in General Practice

In a 3‐year prospective study, the prevalence of albuminuria and its relationship to macrovascular disease, pre‐existing vascular risk factors and mortality rate were studied in a random cohort of 290 patients with Type 2 diabetes mellitus in general practice. Newly occurring micro‐ or macroalbuminuria was associated with significantly ( p < 0.05) higher systolic blood pressure: median (IQ range) 157 (140–170) vs 150 (130–160) mmHg, in addition to higher serum triglycerides: median (IQ range) 2.71 (1.84–4.25) vs 1.84 (1.35–3.14) mmol I −1 , and C‐peptide levels: median (IQ range) 1.30 (0.98–2.16) vs 1.10 (0.82–1.58) nmol I −1 , at 3‐year follow‐up. Patients with macroalbuminuria at final examination had significantly higher systolic and diastolic blood pressure, serum triglyceride and β 2 ‐microglobulin levels, decreased HDL‐cholesterol, and a significantly higher prevalence of carotid artery stenoses and peripheral vascular disease. Patients dying from vascular causes showed significantly higher urinary albumin levels at entrance as compared to the surviving patients: median (IQ range): 42.2 (11–249.7) vs 10.4 (4.6–28.0) mg I −1 , p < 0.008, and overall mortality rate was significantly linked with the presence of macroalbuminuria (26% vs 5% in normoalbuminuric patients). A comparison between the results of the initial and the final examination indicated an overall worsening of renal variables (albuminuria: median (IQ range): female 9.5 (4.5–21) vs 13.4 (5.1–39.7) mg I −1 , ( p < 0.05); male 13.8 (4.7–34.1) vs 32.6 (8.1–78.7) ( p < 0.001), despite a significant improvement in metabolic variables. At the same time, a significant increase of the prevalence of peripheral vascular disease (female 41 vs 59%, p<0.005; male 35 vs 47%, p < 0.05; 95% confidence interval: female 33–49% vs 51–67%; male 25–46% vs 36–58%) and stenoses of the carotid artery (female 8.6 vs 18%, p < 0.05 and male 4.8 vs 16%, p < 0.005, 95% CI: female 4.8–14% vs 12.4–24.8%, male 1.3–11.9 vs 8.8–25.9) was found. Macroalbuminuria in particular appears to be a marker of peripheral vascular disease accompanied by a number of risk factors commonly seen in the context of Syndrome X, and predicts macrovascular deaths.