Changes in Albumin Excretion in the Diabetes Prevention Program
- Diabetes Prevention Program Research Group*
- Address correspondence to the Diabetes Prevention Program Coordinating Center, dppmail{at}biostat.bsc.gwu.edu.
Abstract
OBJECTIVE Increased urinary albumin excretion rates have been linked to nephropathy and macrovascular disease. We here describe the baseline prevalence and effect of Diabetes Prevention Program (DPP) interventions on the development and reversal of elevated albumin excretion.
RESEARCH DESIGN AND METHODS Urine albumin-to-creatinine ratios (ACRs) were calculated from untimed urine collections. Analyses compared participants by treatment group, diabetes and hypertension status, and use of ACE inhibitors or angiotensin II receptor blockers (ARBs).
RESULTS Elevated ACR levels (≥30 mg/g creatinine) were present at baseline in 198 (6.2%) of 3,188 participants: placebo 5.3%, metformin 6.5%, and intensive lifestyle (ILS) 6.8%. Of the 2,802 with ACR measurements at baseline and at the end of the study, the percentage with elevated levels declined (incident and regression) from 6.2 to 6.1%, with no significant differences between the groups even with adjustment for ACE inhibitor and ARB use. The odds of developing an elevated ACR were 59% higher for a participant who developed diabetes compared with one who did not.
CONCLUSIONS At entry into the DPP, an elevated ACR was present in 6.2%. Despite the marked decrease in progression to diabetes and the improvement in insulin resistance and other cardiovascular risk markers in the ILS and metformin groups, there was no improvement in ACR, on average, in those two groups. However, the frequency of an elevated ACR was higher in participants who developed diabetes. An increased ACR may have multiple causes, thus obscuring the improvements that might have been expected with the reduction in insulin resistance seen in the DPP.
Footnotes
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↵*A full list of the writing group for the Diabetes Prevention Program Research Group can be found in the appendix.
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Representatives of the National Institutes of Health and the Centers for Disease Control and Prevention participated in the design of the study and in the reporting of the results. Although additional funding was provided by a variety of other sources, as listed in the acknowledgments, these sources had no role in the design or conduct of the study or in the reporting of results.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- © 2009 by the American Diabetes Association.
