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Predictive factors of progression from normoalbuminuria to microalbuminuria in Type 1 diabetic patients

The aim of this study was to establish risk factors associated with the progression of the urinary excretion rate (UAE)in normoalbuminuric type 1 diabetic patients. A total of 100 type 1 diabetic patients with minimum diabetes duration of 5 years were included.HbA1c, lipid profile, smoking status, 24-h UAE, 24-hr ambulatory blood pressure monitoring (AMBP) and a battery of of cardiovascular refelex tests were assessed at the beginning of the study and every six months during the follow up period of 5 years. Urinary albumin concentration was determined by an immunoturbidimetric assay. Twenthy four hour blood pressure monitoring was performed by an oscilometric method and patients were classified according to night/day diastolic blood pressure (dBP)ratio > or < 0, 9 as dippers and non-dippers. Tests of heart rate variation (HRV) included the coefficient of variation (CV) and the low-frequency, midfrequency(MF)and high-frequency (HF) bands of spectral analysis at rest, HRV during deep breathing (CV, mean circular resultant), Valsalva ratio and maximum/minimum 30:15 ratio.Autonomic neuropathy was characterized as an abnormality of more than two tests. Patients who progressed to microalbuminuria showed higher HbA1c value (8, 9 vs. 6, 7%, p<0, 05)and longerdiabetes duration (10, 8 vs 7, 0 years, p<0, 05)at baseline compared to nonprogressors.There was an overrepresentation of non-deepers (74 vs. 24%, p<0, 05)in patients who progressed to microalbuminuria compared to those who did not.Autonomic neuropathy was more often seen in progressors than in nonprogressors at baseline (68 vs. 14%, p<0, 001). Age, gender, smoking status and lipid profile did not differ between progressors and nonprogressors. In a multiple logistic regression analysis, night/day dBP ratio (p=0, 001) and autonomic neuropathy (p=0, 001)were independent predictors of progression of UAE. An impaired night dBP fall and autonomic neuropathy are independent risk factors for progression of UAE in normoalbuminuric type 1 diabetic patients.

urinary albumin excretion; autonomic neuropathy; type 1 diabetes

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