Rate of Progression of Albuminuria in Type II Diabetes: Five-year prospective study from South India

OBJECTIVE: To evaluate the potential risk factors for the progression of albuminuria in type II diabetes. RESEARCH DESIGN AND METHODS: A cohort of 481 type II diabetic patients were followed prospectively for 5 years. Blood glucose (BG) and blood pressure (BP) were checked at 2 monthly intervals, and urinary albumin excretion (UAE) was checked at yearly intervals. Progression of albuminuria was recognized by the development of microalbuminuria and macroalbuminuria and a significant increase in albuminuria within the microalbuminuric range. RESULTS: UAE was normal in 349 patients, 93 patients were microalbuminuric, and the rest (39) were macroalbuminuric. Sixty-two patients with normal UAE developed microalbuminuria. Ten patients with normoalbuminuria and 23 with microalbuminuria developed macroalbuminuria during the 5-year observation period with overall incidence of 46.9/1,000 person-years for normoalbuminuria and 58.7/1,000 person-years for microalbuminuria. Baseline UAE was significantly higher in those patients who progressed compared with those patients who did not (normoalbuminuria: 8.5 +/- 6 vs. 5.3 +/- 4 micrograms/min, P < 0.001; microalbuminuria: 68.5 +/- 57 vs. 47.4 +/- 34 micrograms/min, P < 0.01). Multiple regression analysis revealed initial UAE and diabetes duration to be predictors of albuminuria progression. CONCLUSIONS: Initial UAE is a strong predictor of albuminuria progression in type II diabetic patients.