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Previous Volume 332:1251-1255 May 11, 1995 Number 19 Next

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ABSTRACT

Background The risk of microalbuminuria in patients with insulin-dependent diabetes mellitus (IDDM) is thought to depend on the degree of hyperglycemia, but the relation between the degree of hyperglycemia and urinary albumin excretion has not been defined.

Methods We measured urinary albumin excretion in three random urine samples obtained at least one month apart from 1613 patients with IDDM. Microalbuminuria or overt albuminuria was considered to be present if the ratio of albumin (in micrograms) to creatinine (in milligrams) was 17 to 299 or >300, respectively, for men and 25 to 299 or >300, respectively, for women. Measurements of glycosylated hemoglobin (hemoglobin A₁) obtained up to four years before the urine testing were used as an index of hyperglycemia. Twelve percent of the patients had overt albuminuria and were excluded from subsequent analyses.

Results The prevalence of microalbuminuria was 18 percent in patients with IDDM. It increased with increasing postpubertal duration of diabetes and, within each six-year interval of disease duration, it increased nonlinearly with the hemoglobin A₁ value. For hemoglobin A₁ values below 10.1 percent, the slope of the relation was almost flat, whereas for values above 10.1 percent, the prevalence of microalbuminuria rose steeply (P<0.001). For example, as the hemoglobin A₁ value increased from 8.1 to 10.1 percent, the odds of microalbuminuria increased by a factor of 1.3, but as the value increased from 10.1 to 12.1 percent, the odds were increased by a factor of 2.4.

Conclusions The risk of microalbuminuria in patients with IDDM increases abruptly above a hemoglobin A₁ value of 10.1 percent (equivalent to a hemoglobin A_1c value of 8.1 percent), suggesting that efforts to reduce the frequency of diabetic nephropathy should be focused on reducing hemoglobin A₁ values that are above this threshold.

Source Information

From the Epidemiology and Genetics Section, Research Division, Joslin Diabetes Center (A.S.K., L.M.B.L., M.K., M.Q., J.H.W.); the Departments of Medicine (A.S.K.) and Pediatrics (L.M.B.L., M.Q.), Harvard Medical School; and the Department of Epidemiology, Harvard School of Public Health (A.S.K., J.H.W.) — all in Boston.

Address reprint requests to Dr. Krolewski at the Epidemiology and Genetics Section, Joslin Diabetes Center, 1 Joslin Pl., Boston, MA 02215-5397.

Full Text of this Article

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• Davidson, M. B., Schriger, D. L., Peters, A. L., Lorber, B. (1999). Relationship Between Fasting Plasma Glucose and Glycosylated Hemoglobin: Potential for False-Positive Diagnoses of Type 2 Diabetes Using New Diagnostic Criteria. JAMA 281: 1203-1210 [Abstract] [Full Text]  
• Ravid, M., Brosh, D., Ravid-Safran, D., Levy, Z., Rachmani, R. (1998). Main Risk Factors for Nephropathy in Type 2 Diabetes Mellitus Are Plasma Cholesterol Levels, Mean Blood Pressure, and Hyperglycemia. Arch Intern Med 158: 998-1004 [Abstract] [Full Text]  
• Gaster, B., Hirsch, I. B. (1998). The Effects of Improved Glycemic Control on Complications in Type 2 Diabetes. Arch Intern Med 158: 134-140 [Abstract] [Full Text]  
• Haffner, S. M. (1997). Is There a Glycemic Threshold?. Arch Intern Med 157: 1791-1791 [Abstract]  
• Orchard, T. J., Forrest, K. Y.-Z., Ellis, D., Becker, D. J. (1997). Cumulative Glycemic Exposure and Microvascular Complications in Insulin-Dependent Diabetes Mellitus: The Glycemic Threshold Revisited. Arch Intern Med 157: 1851-1856 [Abstract]  
• Abraira, C., Colwell, J., Nuttall, F., Sawin, C. T., Henderson, W., Comstock, J. P., Emanuele, N. V., Levin, S. R., Pacold, I., Lee, H. S. (1997). Cardiovascular Events and Correlates in the Veterans Affairs Diabetes Feasibility Trial: Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes. Arch Intern Med 157: 181-188 [Abstract]  
• Holownia, P., Bishop, E., Newman, D. J., John, W. G., Price, C. P. (1997). Adaptation of latex-enhanced assay for percent glycohemoglobin to a Dade Dimension(R) analyzer. Clin. Chem. 43: 76-84 [Abstract] [Full Text]  
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• Peters, A. L., Davidson, M. B., Schriger, D. L., Hasselblad, V. (1996). A Clinical Approach for the Diagnosis of Diabetes Mellitus: An Analysis Using Glycosylated Hemoglobin Levels. JAMA 276: 1246-1252 [Abstract]  
• Angulo, J., Sanchez-Ferrer, C. F., Peiro, C., Marin, J., Rodriguez-Manas, L. (1996). Impairment of Endothelium-Dependent Relaxation by Increasing Percentages of Glycosylated Human Hemoglobin: Possible Mechanisms Involved. Hypertension 28: 583-592 [Abstract] [Full Text]  
• Marshall, C. L., Bluestein, M., Chapin, C., Davis, T., Gersten, J., Harris, C., Hodgin, A., Larsen, W., Rigberg, H., Krishnaswami, V., Darling, B. (1996). Outpatient Management of Diabetes Mellitus in Five Arizona Medicare Managed Care Plans. American Journal of Medical Quality 11: 87-93 [Abstract]  
• Kiberd, B. A, Jindal, K. K (1995). Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation. BMJ 311: 1595-1599 [Abstract] [Full Text]  
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• Viberti, G. (1995). A Glycemic Threshold for Diabetic Complications?. NEJM 332: 1293-1294 [Full Text]  
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