A SCREENING-PROGRAM FOR MICROALBUMINURIA AT A DIABETES CLINIC IN APULIA, SOUTHERN ITALY

Microalbuminuria is a predictor of renal and cardiovascular disease in both type 1 (insulin-dependent) and type 2 (insulin-independent) diabetes. We report on a screening programme for microalbuminuria at a diabetes clinic in Italy. All diabetic patients without Albustix-positive proteinuria attending the clinic between April and September 1991 were screened. Microalbuminuria was defined as a urinary albumin/creatinine ratio, on an early morning sterile urine sample, > 3 in at least two consecutive urine collections. Three hundred and fifty patients, 45 (20 female, 25 female) type 1 and 305 (145 male, 160 female) type 2 diabetics, were examined. The age range was 18-42 years and 36-73 years and duration of diabetes 1-24 and 1-35 years for type 1 and type 2 diabetic patients respectively. Blood pressure, lipids, glycosylated haemoglobin, body mass index and insulin dose, where appropriate, were measured in all patients. Microalbuminuria was found in 8 (22%) of the type 1 diabetics. These patients had a longer duration of diabetes (17.5 vs 7.4 years, P < 0.001), higher diastolic blood pressure (86 +/- 2.1 vs 76 +/- 2.6 mmHg, P < 0.05) and an increased total serum cholesterol level (203 +/- 23 vs 180 +/- 25 mg/dl, P < 0.05) compared with diabetic patients with microalbuminuria. Of the type 2 diabetic patients 95 (33%) were found to have microalbuminuria and 210 (69%) normoalbuminuria. The prevalence of hypertension (defined blood pressure > 140/90 mmHg or antihypertensive treatment) and of dyslipidaemia (defined as total cholesterol > 200 and triglycerides > 170 or hypolipidaemic treatment) were significantly higher (P < 0.001 and 0.01 respectively) in patients with microalbuminuria. This study shows a prevalence of microalbuminuria in type 1 and type 2 diabetic patients similar to that reported in surveys of diabetes clinic outpatients in northern Europe. The association between microalbuminuria and recognized risk factors for cardiovascular and renal disease justifies screening programmes for microalbuminuria for early detection of ''at-risk'' diabetic patients and for the implementation of preventive therapeutic measures.