Urinary Albumin Excretion and Its Relation With C-Reactive Protein and the Metabolic Syndrome in the Prediction of Type 2 Diabetes
- Auke H. Brantsma, MD1,
- Stephan J.L. Bakker, MD, PHD2,
- Hans L. Hillege, MD, PHD3,
- Dick de Zeeuw, MD, PHD4,
- Paul E. de Jong, MD, PHD1,
- Ronald T. Gansevoort, MD, PHD1 and
- the PREVEND Study Group
- 1Division of Nephrology, Department of Medicine, University Medical Center Groningen, Groningen, the Netherlands
- 2Department of Medicine, University Medical Center Groningen, Groningen, the Netherlands
- 3Trial Coordination Center, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
- 4Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
- Address correspondencereprint requests to Ronald T. Gansevoort, MD, PhD, Division of Nephrology, Dept. of Medicine, University Medical Center Groningen, P.O. Box 30,001, 9700 RB, Groningen, Netherlands. E-mail: r.t.gansevoort{at}int.umcg.nl
Abstract
OBJECTIVE—To investigate urinary albumin excretion (UAE) and its relation with C-reactive protein (CRP) and the metabolic syndrome in the prediction of the development of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We used data from the Prevention of Renal and Vascular End Stage Disease (PREVEND) study, an ongoing, community-based, prospective cohort study initiated in 1997 in the Netherlands. The initial cohort consisted of 8,592 subjects. After 4 years, 6,894 subjects participated in a follow-up survey. Subjects with diabetes at baseline or missing data on fasting glucose were excluded, leaving 5,654 subjects for analysis. The development of type 2 diabetes, defined as a fasting glucose ≥7.0 mmol/l and/or the use of antidiabetic medication, was used as the outcome measure. UAE was calculated as the mean UAE from two consecutive 24-h urine collections. Logistic regression models were used, with the development of type 2 diabetes as the dependent variable.
RESULTS—Of the 5,654 subjects for whom data were analyzed, 185 (3.3%) developed type 2 diabetes during a mean follow-up period of 4.2 years. UAE, CRP, and the presence of the metabolic syndrome at baseline were significantly associated with the incidence of type 2 diabetes (P < 0.001 for all variables). In a univariate model, the odds ratio (OR) for UAE was 1.59 (95% CI 1.42–1.79). In our full model, adjusted for age, sex, number of criteria of metabolic syndrome, and other known risk factors for the development of type 2 diabetes (including fasting insulin), the association between UAE and type 2 diabetes remained significant (OR 1.53, 95% CI 1.25–1.88, P < 0.001). There was a significant interaction between UAE and CRP (P = 0.002). After CRP was stratified into tertiles, the ORs for the association between baseline UAE and the development of type 2 diabetes were 2.2 (1.47–3.3), 1.33 (0.96–1.84), and 1.04 (0.83–1.31) for the lowest to highest tertiles, respectively.
CONCLUSIONS—UAE predicts type 2 diabetes independent of the metabolic syndrome and other known risk markers of development of type 2 diabetes. The predictive value of UAE was modified by the level of CRP.
- AUC, area under the curve
- CRP, C-reactive protein
- PREVEND, Prevention of Renal and Vascular End Stage Disease
- UAE, urinary albumin excretion
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted July 27, 2005.
- Received March 31, 2005.
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