Medicinski arhiv · 2002
[Risk factors for the development of persistent proteinuria in patients with type 2 diabetes mellitus].
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Kulenović Indira
Аннотация
BACKGROUND: The natural history of diabetic nephropathy is well defined in type 1 diabetes, but to a lesser degree in type 2 diabetes, possibly due to diversity of involved risk-factors. The main aim of the study was to assess modifiable and nonmodifiable risk-factors in the development of persistent proteinuria in patients with type 2 diabetes mellitus.
METHODS: A random sample of 90 diabetic patients, regularly checked up at the Department of Endocrinology, was selected and followed up in a period of 5 years. There were 46 males and 44 females, aged 51.8 +/- 9.9 years, with average duration of disease of 6.8 +/- 5.2 years, including 58 (64.4%) hypertensive patients and 58 (64.4%) smokers. All the participants had fasting and postprandial glycaemia, Hbalc, 24/hour proteinuria and blood pressure measured. Only 4 (4.4%) persons had 24/h proteinuria > 200 mg/d at the beginning of the study.
RESULTS: In a 5 year period, 21 (23.3%) patient developed proteinuria of > 200 mg/d. The main prognostic factors were Hbalc values (RR 3.5, p = 0.03), duration of the disease (RR 3.1, p = 0.02), hypertension (RR 2.9, p = 0.02), with stronger impact of diastolic than systolic values (RR 2.01 vs RR 1.83), age (RR 1.35, p = 0.02), glycaemia with stronger correlation of postprandial than fasting values (RR 1.52 vs 1.34), smoking (RR 1.26, p = 0.06) while sex and BMI values were not strongly associated with the development of the proteinuria (RR 1.09 and RR 1.01 respectively).
CONCLUSIONS: Results indicate that, in addition to glycemic control, control of additional modifiable risk-factors, particularly hypertension and smoking, is of utmost importance in the treatment of patients with type 2 diabetes mellitus.
METHODS: A random sample of 90 diabetic patients, regularly checked up at the Department of Endocrinology, was selected and followed up in a period of 5 years. There were 46 males and 44 females, aged 51.8 +/- 9.9 years, with average duration of disease of 6.8 +/- 5.2 years, including 58 (64.4%) hypertensive patients and 58 (64.4%) smokers. All the participants had fasting and postprandial glycaemia, Hbalc, 24/hour proteinuria and blood pressure measured. Only 4 (4.4%) persons had 24/h proteinuria > 200 mg/d at the beginning of the study.
RESULTS: In a 5 year period, 21 (23.3%) patient developed proteinuria of > 200 mg/d. The main prognostic factors were Hbalc values (RR 3.5, p = 0.03), duration of the disease (RR 3.1, p = 0.02), hypertension (RR 2.9, p = 0.02), with stronger impact of diastolic than systolic values (RR 2.01 vs RR 1.83), age (RR 1.35, p = 0.02), glycaemia with stronger correlation of postprandial than fasting values (RR 1.52 vs 1.34), smoking (RR 1.26, p = 0.06) while sex and BMI values were not strongly associated with the development of the proteinuria (RR 1.09 and RR 1.01 respectively).
CONCLUSIONS: Results indicate that, in addition to glycemic control, control of additional modifiable risk-factors, particularly hypertension and smoking, is of utmost importance in the treatment of patients with type 2 diabetes mellitus.