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Diabetes Publish Ahead of Print published online ahead of print March 15, 2007
DOI: 10.2337/db06-1646
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Original Research

Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes mellitus

Shin-ichi Araki, MD, PhD1, Masakazu Haneda, MD, PhD2, Daisuke Koya, MD, PhD3, Hideki Hidaka, MD, PhD4, Toshiro Sugimoto, MD, PhD1, Motohide Isono, MD, PhD1, Keiji Isshiki, MD, PhD1, Masami Chin-Kanasaki, MD, PhD1, Takashi Uzu, MD, PhD1, and Atsunori Kashiwagi, MD, PhD1

1Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
2Second Department of Medicine, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
3Department of Medicine, Division of Endocrinology & Metabolism, Kanazawa Medical School, Kahoku-gun, Ishikawa, Japan
4 Medical and Health Care Center, SANYO Electric Group Health Insurance Association, Moriguchi, Osaka, Japan

Correspondence: araki{at}belle.shiga-med.ac.jp

Objective.: Microalbuminuria in diabetic patients is a predictor for diabetic nephropathy and cardiovascular disease. The aim of this study is to investigate the clinical impact of reducing microalbuminuria in type 2 diabetic patients in an observational follow-up study.

Research Design and Methods.: We enrolled 216 type 2 diabetic patients with microalbuminuria during an initial two-year evaluation period and then observed them for the next eight years. Remission and a 50% reduction of microalbuminuria were defined as a shift to normoalbuminuria and a reduction below 50% from the initial level of microalbuminuria. The association between reducing microalbuminuria and first occurrence of renal and cardiovascular event, and annual decline rate of estimated glomerular filtration rate (eGFR), was evaluated.

Results.: Twelve events occurred in 93 patients who attained a 50% reduction of microalbuminuria during the follow-up, versus 35 events in 123 patients without a 50% reduction. The cumulative incidence rate of events was significantly lower in patients with a 50% reduction. A pooled logistic regression analysis revealed that the adjusted risk for events in subjects after a 50% reduction was 0.41 (95% CI: 0.15-0.96). In addition, the annual decline rate of eGFR in patients with a 50% reduction was significantly slower than in those without such a reduction. The same results were also found in the analysis regarding whether or not remission occurred.

Conclusions.: The present study provides clinical evidence implying that a reduction of microalbuminuria in type 2 diabetic patients is an integrated indicator for renal and cardiovascular risk reduction.


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