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The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II

BACKGROUND: Increased urinary albumin excretion (UAE) in diabetes is a sensitive marker of microvascular injury and a reliable predictor of cardiovascular outcomes. Hypertension-induced hemodynamic pressure load, diabetes-related metabolic processes and large artery stiffening have all been implicat...

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Autores principales: Nikolaidou, Barbara, Gkaliagkousi, Eugenia, Anyfanti, Panagiota, Gavriilaki, Eleni, Lazaridis, Antonios, Triantafyllou, Areti, Zografou, Ioanna, Douma, Stella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137425/
https://www.ncbi.nlm.nih.gov/pubmed/32252655
http://dx.doi.org/10.1186/s12882-020-01774-0
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author Nikolaidou, Barbara
Gkaliagkousi, Eugenia
Anyfanti, Panagiota
Gavriilaki, Eleni
Lazaridis, Antonios
Triantafyllou, Areti
Zografou, Ioanna
Douma, Stella
author_facet Nikolaidou, Barbara
Gkaliagkousi, Eugenia
Anyfanti, Panagiota
Gavriilaki, Eleni
Lazaridis, Antonios
Triantafyllou, Areti
Zografou, Ioanna
Douma, Stella
author_sort Nikolaidou, Barbara
collection PubMed
description BACKGROUND: Increased urinary albumin excretion (UAE) in diabetes is a sensitive marker of microvascular injury and a reliable predictor of cardiovascular outcomes. Hypertension-induced hemodynamic pressure load, diabetes-related metabolic processes and large artery stiffening have all been implicated in the development of microalbuminuria. We investigated whether hyperglycemia per se, or rather increased blood pressure (BP) and macrovascular dysfunction, is a stronger predictor of UAE at the earliest stages of diabetes. METHODS: Consecutive newly diagnosed patients with diabetes type 2, who were normoglycemic within a year’s time prior to diagnosis, were enrolled. UAE was estimated in 24-h urine samples. Both office and 24-h ambulatory BP was recorded. Arterial stiffness was evaluated by measurement of carotid-femoral pulse wave velocity (PWV) with applanation tonometry. RESULTS: Among 71 newly diagnosed patients with median diabetes duration of just 1 month, 15.5% presented microalbuminuria. UAE did not differ between hypertensive and normotensive diabetics; however, newly diagnosed patients for both hypertension and diabetes exhibited significantly higher levels of UAE, compared to diabetic patients with long-standing hypertension. UAE strongly and significantly correlated with office systolic BP, HbA1c, PWV and estimated glomerular filtration rate. However, in the multivariate analysis adjusting for these factors, only HbA1c was independently associated with UAE (beta = 0.278, p = 0.049). CONCLUSIONS: Hyperglycemic state emerges as a powerful predictor of increased UAE even at the earliest stages of diabetes. The relative contribution of hypertension and macrovascular dysfunction to the development of microalbuminuria seems to be obscured by hyperglycemia, even in patients whose diabetes onset does not exceed a few months’ time.
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spelling pubmed-71374252020-04-11 The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II Nikolaidou, Barbara Gkaliagkousi, Eugenia Anyfanti, Panagiota Gavriilaki, Eleni Lazaridis, Antonios Triantafyllou, Areti Zografou, Ioanna Douma, Stella BMC Nephrol Research Article BACKGROUND: Increased urinary albumin excretion (UAE) in diabetes is a sensitive marker of microvascular injury and a reliable predictor of cardiovascular outcomes. Hypertension-induced hemodynamic pressure load, diabetes-related metabolic processes and large artery stiffening have all been implicated in the development of microalbuminuria. We investigated whether hyperglycemia per se, or rather increased blood pressure (BP) and macrovascular dysfunction, is a stronger predictor of UAE at the earliest stages of diabetes. METHODS: Consecutive newly diagnosed patients with diabetes type 2, who were normoglycemic within a year’s time prior to diagnosis, were enrolled. UAE was estimated in 24-h urine samples. Both office and 24-h ambulatory BP was recorded. Arterial stiffness was evaluated by measurement of carotid-femoral pulse wave velocity (PWV) with applanation tonometry. RESULTS: Among 71 newly diagnosed patients with median diabetes duration of just 1 month, 15.5% presented microalbuminuria. UAE did not differ between hypertensive and normotensive diabetics; however, newly diagnosed patients for both hypertension and diabetes exhibited significantly higher levels of UAE, compared to diabetic patients with long-standing hypertension. UAE strongly and significantly correlated with office systolic BP, HbA1c, PWV and estimated glomerular filtration rate. However, in the multivariate analysis adjusting for these factors, only HbA1c was independently associated with UAE (beta = 0.278, p = 0.049). CONCLUSIONS: Hyperglycemic state emerges as a powerful predictor of increased UAE even at the earliest stages of diabetes. The relative contribution of hypertension and macrovascular dysfunction to the development of microalbuminuria seems to be obscured by hyperglycemia, even in patients whose diabetes onset does not exceed a few months’ time. BioMed Central 2020-04-06 /pmc/articles/PMC7137425/ /pubmed/32252655 http://dx.doi.org/10.1186/s12882-020-01774-0 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Nikolaidou, Barbara
Gkaliagkousi, Eugenia
Anyfanti, Panagiota
Gavriilaki, Eleni
Lazaridis, Antonios
Triantafyllou, Areti
Zografou, Ioanna
Douma, Stella
The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II
title The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II
title_full The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II
title_fullStr The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II
title_full_unstemmed The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II
title_short The impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type II
title_sort impact of hyperglycemia on urinary albumin excretion in recent onset diabetes mellitus type ii
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137425/
https://www.ncbi.nlm.nih.gov/pubmed/32252655
http://dx.doi.org/10.1186/s12882-020-01774-0
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