In patients with type 1 diabetes and microalbuminuria treated with ACE inhibitors, progression to proteinuria occurred at 6.3/100 person-years, predicted by poor glycemic control and high cholesterol.
Cohort (n=373)
What are the determinants of progression from microalbuminuria to proteinuria in patients with type 1 diabetes treated with ACE inhibitors?
Despite ACE inhibitor treatment, many patients with type 1 diabetes and microalbuminuria progress to proteinuria, driven largely by poor glycemic control and elevated cholesterol.
The aims of this study were to assess the frequency and determinants of (1) treatment with angiotensin-converting enzyme inhibitors (ACE-I) and (2) progression to proteinuria in the presence of ACE-I treatment in patients with type 1 diabetes and microalbuminuria. A clinic-based cohort study of patients with type 1 diabetes was begun in 1991. The patients who were included in this study (n = 373) are the cohort members who received a diagnosis of microalbuminuria during a 2-yr baseline observation and were followed for 10 yr with frequent assessments of urinary albumin excretion and biennial examinations. Progression to proteinuria occurred when the median urinary albumin excretion during a 2-yr interval exceeded 299 mug/min. During the decade-long study, the proportion of patients who had a history of microalbuminuria and were treated with ACE-I rose from 17 to 67%. Patients who started this treatment had (on average) higher BP, higher urinary albumin excretion, and longer diabetes duration than those who did not. Microalbuminuria often progressed to proteinuria (6.3/100 person-years) in those who were treated. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors of this progression. Although treatment with ACE-I increased during the past decade, it was not completely effective, because microalbuminuria progressed to proteinuria in many treated patients. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors for progression while on ACE-I treatment. The mechanisms that are responsible for the frequent failure of ACE-I to prevent progression of microalbuminuria to proteinuria in a clinical setting are not clear.
Ficociello et al. (Wed,) conducted a cohort in Type 1 diabetes and microalbuminuria (n=373). Angiotensin-converting enzyme inhibitors (ACE-I) was evaluated on Progression to proteinuria (median urinary albumin excretion >299 mug/min during a 2-yr interval). In patients with type 1 diabetes and microalbuminuria treated with ACE inhibitors, progression to proteinuria occurred at 6.3/100 person-years, predicted by poor glycemic control and high cholesterol.