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Titolo:
Prevalence and risk factors of microalbuminuria in a cohort of African-American women with gestational diabetes
Autore:
Go, RCP; Desmond, R; Roseman, JM; Bell, DSH; Vanichanan, C; Acton, RT;
Indirizzi:
Univ Alabama, Dept Epidemiol, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 Epidemiol, Birmingham, AL 35294 USA Univ Alabama, Ctr Comprehens Canc, Biostat Unit, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 ostat Unit, Birmingham, AL 35294 USA Univ Alabama, Dept Med, Div Endocrinol & Metab, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 ol & Metab, Birmingham, AL 35294 USA Univ Alabama, Dept Microbiol, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 Microbiol, Birmingham, AL 35294 USA
Titolo Testata:
DIABETES CARE
fascicolo: 10, volume: 24, anno: 2001,
pagine: 1764 - 1769
SICI:
0149-5992(200110)24:10<1764:PARFOM>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
TREATED HYPERTENSIVE MEN; INSULIN-RESISTANCE; CARDIOVASCULAR MORTALITY; SYSTOLIC HYPERTENSION; NONDIABETIC SUBJECTS; BLOOD-PRESSURE; NIDDM PATIENTS; POPULATION; MELLITUS; PREDICTOR;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
57
Recensione:
Indirizzi per estratti:
Indirizzo: Go, RCP Univ Alabama, Sch Publ Hlth, Dept Epidemiol & Int Hlth, 1665 Univ Blvd,Ryals Publ Hlth Bldg,Room 230N, Birmingham, AL 35294 USA Univ Alabama 1665 Univ Blvd,Ryals Publ Hlth Bldg,Room 230N Birmingham AL USA 35294
Citazione:
R.C.P. Go et al., "Prevalence and risk factors of microalbuminuria in a cohort of African-American women with gestational diabetes", DIABET CARE, 24(10), 2001, pp. 1764-1769

Abstract

OBJECTIVE - To Study the prevalence of microalbuminuria (MA) in African-American women with a history of gestational diabetes (GDM) who are at high risk for insulin resistance and renal dysfunction and to study MA's relationto insulin resistance, type 2 diabetes, and hypertension. RESEARCH DESIGN AND METHODS - MA was assessed using 24-h, Limed, and/or random urine samples in a cross-sectional sample (n = 289) from a cohort of African-American women with a history of GDM and followed for a median of I I years (range 3.0 - 18.4) since their diabetic pregnancy. Subjects with a urine albumin excretion rate of 30-300 g/24 h or 30-300 mug/mg creatinine in a random sample were classified as having MA if two of three samples overa 3- to 6-month period were positive. These women were evaluated for family history of diabetes, smoking and alcohol use, BMI, diabetes, hypertension, and lipid abnormalities. Insulin sensitivity was determined using the homeostasis model assessment (HOMA) estimates, which used fasting insulin and glucose measurements obtained at the same time as the MA urine sample. RESULTS - At MA assessment, the women ranged in age from 22 to 57 years, with a median of 39 years. The overall prevalence of MA was 20%; 36% in those with diabetes. Those women with MA had higher rates of diabetes (63.8 vs.28.6%, odds ratio [OR] = 4.4, P < 0.05), hypertension (82.8 vs. 42.9%, OR = 6.4, P < 0.05), and family history of diabetes (85.7 vs. 61.7%, OR = 3.7,P < 0.05). The proportion of subjects with MA with a family history of hypertension was nonsignificantly increased (92.9 vs. 82.4%). Subjects with MAwere more obese (BMI 37.2 +/- 8.9 vs. 34.4 +/- 8.6 kg/m(2)) and had higherlevels of HbA(1c) (8.8 +/- 3.3 vs. 6.6 +/- 1.8%, P < 0.001) and systolic (144.3 +/- 25.9 vs. 122.8 +/- 17.2 mmHg, P < 0.0001) and diastolic (95.1 +/-15.4 vs. 82.5 +/- 11.9 mmHg, P < 0.0001) blood pressures. Lipid fractions were similar in those with and without MA. Although fasting glucose was much higher in subjects with MA (10.3 +/- 5.8 vs. 7.1 +/- 4.2 mmol/l, P = 0.0002), insulin levels were not significantly higher in subjects with MA (17.4+/- 21.2 vs. 15.2 +/- 12.4 pmol/l). Insulin sensitivity, as measured usinglog HOMA, was similar (1.5 +/- 0.6 vs. 1.6 +/- 0.6) in women with and without MA, respectively. Multivariable logistic regression analyses indicated that HbA(1c) OR = 1.16 (1.07, 1.27), and systolic blood pressure, OR = 1.27(1.14, 1.41), were independent risk factors for MA. In those with diabetes, the subjects with MA had higher rates of hypertension - 83.8 vs. 56.1%, OR = 4.1 (1.5, 11.10) - which was reflected by their higher systolic and diastolic blood pressures, 146.1 mmHg (P = 0.001) and 94.8 mmHg (P = 0.002), respectively, and lower levels of VLDL (0.45 +/- 0.22 vs. 0.61 +/- 0.33 mmol/l, P = 0.021). In the multivariable analyses of those with diabetes, the two independent risk factors for MA were similar: HbA(1c), OR = 1.13 (1.01, 1.28), and systolic blood pressure, OR = 1.21 (1.04, 1.41). CONCLUSIONS - African-American women with a history of GDM have one of thehighest rates for MA. Presence of MA was not associated with insulin resistance but was significantly independently associated With HbA(1c) levels and hypertension. These results, taken in context of the literature, suggest that hypertension and glucose intolerance, in part, influence MA through different mechanisms. Because of the high prevalence of MA in this populationand MA's relation to all-cause and cardiovascular mortality, screening forMA should be considered.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 23/01/20 alle ore 06:29:33