NDT Advance Access originally published online on November 26, 2007
Nephrology Dialysis Transplantation 2008 23(4):1278-1284; doi:10.1093/ndt/gfm798
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Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study*
1 Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, CH 2 Department of Internal Medicine, La Colletta Hospital, Genoa, Italy 3 Warwick Medical School, University of Warwick, Coventry, UK 4 Department of Internal Medicine, Policlinico Universitario, Messina 5 Metabolism and Diabetes Unit ASL 8, Regione Piemonte, Chieri (TO) 6 Diabetologic Unit, Spedali Civili di Brescia, Brescia 7 Diabetes and Metabolism Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP 8 Unit of Endocrinology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
Antonio Nicolucci, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy. Tel: +39 0872 570260; Fax: +39 0872 570263; E-mail: nicolucci{at}negrisud.it
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Abstract |
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Background. We evaluated to what extent the presence of risk factors and their interactions increased the likelihood of microalbuminuria (MAU) among individuals with type 2 diabetes.
Methods. Fifty-five Italian diabetes outpatient clinics enrolled a sample of patients with type 2 diabetes, without urinary infections and overt diabetic nephropathy. A morning spot urine sample was collected to centrally determine the urinary albumin/creatinine ratio (ACR). A tree-based regression technique (RECPAM) and multivariate analyses were performed to investigate interaction between correlates of MAU.
Results. Of the 1841 patients recruited, 228 (12.4%) were excluded due to the presence of urinary infections and 56 (3.5%) for the presence of macroalbuminuria. Overall, the prevalence of MAU (ACR = 30–299 mg/g) was of 19.1%. The RECPAM algorithm led to the identification of seven classes showing a marked difference in the likelihood of MAU. Non-smoker patients with HbA1c <7% and waist circumference 
102 cm showed the lowest prevalence of MAU (7.5%), and represented the reference class. Patients with retinopathy, waist circumference >98 cm and HbA1c >8% showed the highest likelihood of MAU (odds ratio = 13.7; 95% confidence intervals 6.8–27.6). In the other classes identified, the risk of MAU ranged between 3 and 5. Age, systolic blood pressure, HDL cholesterol levels and diabetes treatment represented additional, global correlates of MAU.
Conclusions. The likelihood of MAU is strongly related to the interaction between diabetes severity, smoking habits and several components of the metabolic syndrome. In particular, abdominal obesity, elevated blood pressure levels and low HDL cholesterol levels substantially increase the risk of MAU. It is of primary importance to monitor MAU in high-risk individuals and aggressively intervene on modifiable risk factors.
Keywords: cardiovascular risk; microalbuminuria; prevalence; RECPAM analysis; type 2 diabetes
* List of investigators: G. Brandoni—Ancona; L. Gentile, S. Guidi—Asti; V. Paciotti, P. Alfidi—Avezzano (AQ); A. Sforza, V. Chiarini—Bologna; L. Rocca, B. Agosti—Brescia; V. Borzì; R.M. Motta, S. Squatrito—Catania; C. Santini, C. Dradi Maraldi—Cesena (FO); C.B. Giorda, E. Nada—Chieri (TO); A. Chiambretti, R. Fornengo—Chivasso (TO); P. Mascetti, G. Carrano—Como; G. Magro, L. Gianotti—Cuneo; A. Giancaterini; N. Musacchio—Cusano Milanino (MI); G. Formentini, M.C. Pilia—Desenzano del Garda (BS); G. Marelli—Desio (MI); C. Baggiore—Firenze; M. Cignarelli, O. Lamacchia—Foggia; C. Taboga, B. Catone—Gemona del Friuli (UD); A. Cattaneo, R. Guido—Genova; L. Cataldi, C. Bordone—Genova; R. Geremia—Giugliano in Campania (NA); F. Quadri, L. Sambuco—Grosseto; P. Tatti, F. Costanza—Marino (RM); A.M. Scarpitta, A. Lo Presti—Marsala (TP); M.A. Dolci—Massa; A. Venezia, R. Morea—Matera; A. Zampino, F. Cervellino—Melfi (PZ); C. Invitti, A. Girola—Milano; V. Manicardi, M. Michelini—Montecchio (RE); F. Sanciu—Olbia; A. Galluzzo, F. Pantò—Palermo; G. Mattina—Palermo; G. Grossi, F. De Berardinis—Paola (CS); S.M. Tardio, M.C. Calderini—Parma; V. Aiello, V. Provenzano—Partinico (PA); I.S. Savulescu, A. Vailati—Pavia; O. Giampietro, I. Chiti—Pisa; R. Gelisio, M. Cabras—Portogruaro (VE); A. Arcangeli, S. Guizzotti—Prato; C. Giovannini—Reggio Calabria; C. Collina, C. Simeoni, S. Leotta, L. Fontana—Roma; S. Genovese, A. Rossi—Rozzano (MI); S. De Cosmo, A. Rauseo—S. Giovanni Rotondo (FG); A. Muscogiuri, A. Maschio—S. Pietro Vernotico (BR); P. Calàtola, L. Lo Conte—Salerno; M. Santangelo, R. Fani—San Benedetto del Tronto (AP); R. Cavani—Sassuolo (MO); F. Calcaterra, F. Cataldi—Schio (VI); A.F. Braione, S. Albano—Taranto; A. Travaglini, A. Di Gianvito—Terni; L. Monge, G. Boffano—Torino; N. Palmieri, C. Fiengo—Torre del Greco (NA); C. Noacco, F. Colucci—Udine.
Received for publication: 2. 8.07
Accepted in revised form: 15.10.07