What is the clinical evidence from this study?

Study design: Cohort. Population: Type 1 diabetes (n=537). Intervention: Risk factor assessment. Primary outcome: Progression from normoalbuminuria to microalbuminuria or macroalbuminuria (RR 2.63, 95% CI 1.65-4.19).

What does this research mean for the field?

Baseline urinary albumin excretion rate, HbA1c levels, presence of retinopathy, and smoking are significant predictors of progression to micro- or macroalbuminuria in patients with type 1 diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 1, 2002Open Access

Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Type 1 Diabetic Patients

Key Result

Baseline log urinary albumin excretion rate (RR 2.63; 95% CI 1.65-4.19), HbA1c, retinopathy, and smoking significantly predicted progression to micro- or macroalbuminuria in type 1 diabetes.

Study Design

Type

Cohort (n=537)

Multicenter

Structured PICO

What are the risk factors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes?

Population

537 patients aged >=18 years with type 1 diabetes, duration >=5 years, normoalbuminuria (urinary albumin excretion rate <=30 mg/24 h), and not taking antihypertensive medication

Outcome

Development of persistent microalbuminuria or macroalbuminuria (>30 mg/24 h in two of three consecutive urine samples)surrogate

Baseline urinary albumin excretion, HbA1c, retinopathy, and smoking are significant predictors of progression to diabetic nephropathy in type 1 diabetes.

Main Result

Effect estimate: RR 2.63 (95% CI 1.65-4.19)

Abstract

OBJECTIVE: To evaluate prospectively putative risk factors for development of microalbuminuria and macroalbuminuria in type 1 diabetes. RESEARCH DESIGN AND METHODS: Prospective observational study of a cohort of type 1 diabetic patients followed in the outpatient clinic at Steno Diabetes Center for or =18 years with type 1 diabetes, with duration of diabetes > or =5 years, with normoalbuminuria (urinary albumin excretion rate 30 mg/24 h in two of three consecutive urine samples). Cox multiple regression analysis using baseline values of putative predictors of progression showed the following significant predictors of progression from normoalbuminuria to microalbuminuria or macroalbuminuria: baseline log urinary albumin excretion rate 2.63 (relative risk; 95% CI 1.65-4.19), HbA(1c) 1.13% (1.04-1.23), presence of any retinopathy 1.90 (1.26-2.88), and smoking 1.61 (1.11-2.33). Sex, duration of diabetes, arterial blood pressure, serum creatinine, height, and social class were not risk factors. CONCLUSIONS: Our study suggests that several potentially modifiable risk factors predict the development of microalbuminuria and macroalbuminuria in type 1 diabetic patients.

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