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Is microalbuminuria part of the prediabetic state? The Mexico City Diabetes Study

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Summary

Microalbuminuria is associated with increased cardiovascular mortality in both diabetic and non-diabetic subjects. A number of studies have indicated that insulin resistance, increased blood pressure and dyslipidaemia precede the onset of clinical diabetes. We examined various correlates of microalbuminuria in 1,298 non-diabetic subjects who participated in the Mexico city Diabetes Study, a population-based study of diabetes and cardiovascular risk factors. Both parental history of diabetes and impaired glucose tolerance were significantly associated with microalbuminuria. These results were not explained by differences in age or blood pressure between subjects with or without a parental history of diabetes or impaired glucose tolerance. In addition, subjects with microalbuminuria had increased 2-h insulin and triglyceride concentrations, a higher prevalence of hypertension, and decreased high density lipoprotein cholesterol concentrations relative to subjects without microalbuminuria. These results suggest that microalbuminuria may be a feature of the prediabetic state.

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References

  1. Friedman EA (1982) Nephrology forum. Diabetic nephropathy: strategies in prevention and management. Kidney Int 21: 780–791.

    CAS  PubMed  Google Scholar 

  2. Fabre J, Balant LP, Dayer PG, Fox HM, Vernet AT (1982) The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int. 21: 730–738.

    CAS  PubMed  Google Scholar 

  3. Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 310:356–360

    CAS  PubMed  Google Scholar 

  4. Nelson RG, Pettitt DJ, Carrahar MJ, Baird HR, Knowler WC (1988) Effect of proteinuria on mortality in NIDDM. Diabetes 37: 1499–1504

    CAS  PubMed  Google Scholar 

  5. Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ (1984) Microalbuminuria predicts mortality in noninsulin-dependent diabetes mellitus. Diabetic Med 1:17–19

    CAS  PubMed  Google Scholar 

  6. Collins VR, Dowse GK, Finch CF, Zimmet PZ, Linnane AW (1989) Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru. Diabetes 38: 1602–1610

    CAS  PubMed  Google Scholar 

  7. Nelson RG, Runzelman CL, Pettitt DJ, Saad MF, Bennett PH, Knowler WC (1989) Albuminuria in Type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians. Diabetologia 32: 870–876

    Article  CAS  PubMed  Google Scholar 

  8. Gatling W, Mullee MA, Knight C, Hill RD (1988) Microalbuminuria in diabetes: relationships between urinary albumin excretion and diabetes-related variables. Diabetic Med 5: 348–351

    CAS  PubMed  Google Scholar 

  9. Schmitz A, Vaeth M (1988) Microalbuminuria: a major risk factor in non-insulin dependent diabetes in a 10-year follow-up study of 503 patients. Diabetic Med 5: 126–134

    CAS  PubMed  Google Scholar 

  10. Knowler WC, Bennett PH, Nelson RG (1988) Prediabetic blood pressure predicts albuminuria after development of NIDDM. Diabetes 37 [Suppl 1]: 120 A (Abstract)

    Google Scholar 

  11. Uusitupa M, Siitonen O, Penttilä I, Aro A, Pyörälä K (1987) Proteinuria in newly diagnosed type II diabetic patients. Diabetes Care 10:191–194

    CAS  PubMed  Google Scholar 

  12. Damsgaard EM, Mogensen CE (1986) Microalbuminuria in elderly hyperglycaemic patients and controls. Diabetic Med 3: 430–435

    CAS  PubMed  Google Scholar 

  13. Keen H, Chouverakis C, Fuller J, Jarrett RJ (1969) The concomitants of raised blood sugar: studies in newly-detected hyperglycaemics. II. Urinary albumin excretion, blood pressure and their relationship to blood sugar levels. Guy's Hospital Rep 118:247–254

    CAS  Google Scholar 

  14. Haffner SM, Stern MP, Gruber MK, Hazuda HP, Mitchell BD, Patterson JK (1990) Microalbuminuria. Potential marker for increased cardiovascular risk factors in non-diabetic subjects? Arteriosclerosis 10: 727–731

    CAS  PubMed  Google Scholar 

  15. Sicree RA, Zimmet PZ, King HOM, Coventry JS (1987) Plasma insulin response among Nauruans: prediction of deterioration in glucose tolerance over six years. Diabetes 36: 179–186

    CAS  PubMed  Google Scholar 

  16. Bogardus C, Lillioja S, Foley J et al. (1987) Insulin resistance predicts the development of non-insulin dependent diabetes mellitus in Pima Indians. Diabetes 36 [Suppl 1]: 47 A (Abstract)

    Google Scholar 

  17. Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett PH (1988) The natural history of impaired glucose tolerance in the Pima Indians. N Engl J Med 319: 1500–1506

    CAS  PubMed  Google Scholar 

  18. Haffner SM, Stern MP, Mitchell BD, Hazuda HP, Patterson JK (1990) Incidence of type II diabetes mellitus in Mexican Americans predicted by insulin and glucose levels, obesity and body fat distribution. Diabetes 39: 283–289

    CAS  PubMed  Google Scholar 

  19. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK (1990) Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 263: 2893–2898

    Article  CAS  PubMed  Google Scholar 

  20. McPhillips JB, Barrett-Connor E, WingardDL (1990) Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin dependent diabetes mellitus in a community of older adults. Am J Epidemiol 131: 443–453

    CAS  PubMed  Google Scholar 

  21. Medalie JH, Papier CM, Goldbourt U, Herman JB (1975) Major factors in the development of NIDDM in 10,000 men. Arch Int Med 135: 811–817

    CAS  Google Scholar 

  22. Stern MP, Gonzalez C, Mitchell BD, Villalpando E, Haffner SM, Hazuda HP (1992) Genetic and environmental determinants of type II diabetes in Mexico City and San Antonio. Diabetes 41: 484–492

    CAS  PubMed  Google Scholar 

  23. Haffner SM, Stern MP, Hazuda HP, Pugh JA, Patterson JK (1987) Do upper body and centralized adiposity measure different aspects of body fat distribution? Relationship to non-insulin dependent diabetes mellitus, lipids and lipoproteins. Diabetes 36: 43–51

    CAS  PubMed  Google Scholar 

  24. Haffner SM, Mitchell BD, Stern MP, Hazuda HP, Patterson JK (1990) Decreased prevalence of hypertension in Mexican Americans. Hypertension 16: 225–232

    CAS  PubMed  Google Scholar 

  25. Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ (1984) Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: the San Antonio Heart Study. Am J Epidemiol 120: 834–851

    CAS  PubMed  Google Scholar 

  26. Haffner SM, Stern MP, Hazuda HP, Pugh JA, Patterson JK (1986) Hyperinsulinaemia in a population at high risk for non-insulin dependent diabetes mellitus. N Engl J Med 315: 220–224

    CAS  PubMed  Google Scholar 

  27. World Health Organization (1985) Diabetes Mellitus. Report of a WHO Study Group. World Health Organization (Technical Report Service Number 727), Geneva

  28. Gatling W, Knight C, Hill RD (1985) Screening for early diabetic nephropathy: which sample to detect microalbuminuria? Diabetic Med 2: 451–455

    CAS  PubMed  Google Scholar 

  29. Cowell CT, Rodgers S, Silkink M (1986) First morning urinary albumin concentration is a good predictor of 24-hour urinary albumin excretion in children with type I (insulin-dependent) diabetes. Diabetologia 29: 97–99

    Article  CAS  PubMed  Google Scholar 

  30. SAS/STAT User's Guide (1988) Release 6.03 Edition. SAS Institute, Cary, NC

  31. Dallal GE (1988) Logistic: a logistic regression program for the IBMPC. Am Statistician 42: 272

    Google Scholar 

  32. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK (1988) Increased insulin concentrations in non-diabetic coffspring of diabetic parents. N Engl J Med 319: 1297–1301

    CAS  PubMed  Google Scholar 

  33. Eriksson J, Fransilla-Kallunki A, Ekstrand A et al. (1989) Early metabolic defects in persons at high risk for non-insulin dependent-diabetes mellitus. N Engl J Med 321: 337–343

    CAS  PubMed  Google Scholar 

  34. Gulli G, Ferrannini E, Stern MP, Haffner SM, DeFronzo RA (1992) The metabolic profile of NIDDM is fully established in normal glucose tolerant offspring of two diabetic parents. Diabetes 41: 1575–1586

    CAS  PubMed  Google Scholar 

  35. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK, Ferrannini E (1989) Parental history of diabetes is associated with increased cardiovascular risk factors. Arteriosclerosis 9: 928–933

    CAS  PubMed  Google Scholar 

  36. Reaven GM (1988) Banting Lecture 1988: role of insulin resistance in human disease. Diabetes 37: 1595–1607

    CAS  PubMed  Google Scholar 

  37. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP (1992) Prospective analysis of the insulin-resistance syndrome (syndrome X). Diabetes 41: 715–722

    CAS  PubMed  Google Scholar 

  38. Ekstrand A, Groop PH, Widen E, Groop L (1991) Microalbuminuria in NIDDM is associated with resistance to the action of insulin on glucose storage. Diabetes 40 [Suppl 1]: 259 A (Abstract)

    Google Scholar 

  39. Nosadini R, Solini A, Sambataro M et al. (1992) Relationships among insulin resistance, hypertension and microalbuminuria in non-insulin dependent diabetes mellitus. Role of cell ion handling. Diabetes 41 [Suppl 1]: 62 A (Abstract)

    Google Scholar 

  40. DeFronzo RA (1981) The effect of insulin on renal sodium metabolism: a review with clinical implications. Diabetologia 21: 165–171

    Article  CAS  PubMed  Google Scholar 

  41. Scholey JW, Meyer TW (1989) Control of glomerular hypertension by insulin administration in diabetic rats. J Clin Invest 83: 1384–1389

    CAS  PubMed  Google Scholar 

  42. Yudkin JS, Forrest RD, Jackson CA (1988) Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington Diabetes Study. Lancet II: 530–533

    Google Scholar 

  43. Mattock MB, Keen H, Viberti GC et al. (1988) Coronary heart disease and urinary albumin excretion rate in type 2 (non-insulindependent) diabetic patients. Diabetologia 31: 82–87

    Article  CAS  PubMed  Google Scholar 

  44. Mattock MB, Morrish NJ, Viberti GC, Keen H, Fitzgerald AP, Jackson G (1992) Prospective study of microalbuminuria as predictor of mortality in NIDDM. Diabetes 41: 736–741

    CAS  PubMed  Google Scholar 

  45. Pollare T, Lithell H, Berne C (1989) A comparison of the effects of hydrocholorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med 321: 868–873

    CAS  PubMed  Google Scholar 

  46. Marre M, Leblanc M, Suarez L, Guyenne TT, Menard J, Passa P (1987) Converting enzyme inhibition and kidney function in normotensive diabetic subjects with persistent microalbuminuria. BMJ 294: 1484–1488

    Google Scholar 

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Authors and Affiliations

  1. Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

    S. M. Haffner, R. A. Valdez, H. P. Hazuda, B. D. Mitchell, A. Monterrosa & M. P. Stern

  2. Centro de Estudios en Diabetes, American British Cowdray Hospital, Mexico City, Mexico

    C. Gonzales

  3. Department of Medicine, Univesity of Kuopio, Kuopio, Finland

    L. Mykkänen

Authors
  1. S. M. Haffner
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  2. C. Gonzales
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  3. R. A. Valdez
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  4. L. Mykkänen
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  5. H. P. Hazuda
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  6. B. D. Mitchell
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  7. A. Monterrosa
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  8. M. P. Stern
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Haffner, S.M., Gonzales, C., Valdez, R.A. et al. Is microalbuminuria part of the prediabetic state? The Mexico City Diabetes Study. Diabetologia 36, 1002–1006 (1993). https://doi.org/10.1007/BF02374491

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