Cardiovascular risk factors and incident albuminuria in screen‐detected type 2 diabetes

D.R. Webb, F. Zaccardi, M.J. Davies, S.J. Griffin, N.J. Wareham, R.K. Simmons, G.E. Rutten, A. Sandbaek, T. Lauritzen, K. Borch‐Johnsen, K. Khunti

It is unclear whether cardiovascular risk factor modification influences the development of renal disease in people with type 2 diabetes identified through screening. We determined predictors of albuminuria five years after a diagnosis of screen-detected diabetes within the ADDITION-Europe study, a pragmatic cardiovascular outcome trial of multifactorial cardiovascular risk management. In 1,826 participants with newly diagnosed, screen-detected diabetes without albumiuria, we explored associations between risk of new albuminuria (≥2.5 mg mmol(-1) males and ≥3.5 mg mmol(-1) females) and: 1) baseline cardio-metabolic risk factors and 2) changes from baseline to one year in systolic blood pressure (∆SBP) and glycated haemoglobin (∆HbA1c ) using logistic regression. Albuminuria developed in 268 (15%) participants; baseline body mass index and active smoking were independently associated with new onset albuminuria in the five years after detection of diabetes. In a model adjusted for age, gender, and baseline HbA1c and blood pressure, a 1% decrease in HbA1c and 5 mmHg decrease in SBP during the first year were independently associated with lower risks of albuminuria (Odds Ratio (OR), 95% confidence interval: 0.76, 0.62 to 0.91 and 0.94, 0.88 to 1.01, respectively). Further adjustment did not materially change these estimates. There was no interaction between ΔSBP and ΔHBA1c in relation to albuminuria risk, suggesting likely additive effects on renal microvascular disease. Baseline measurements and changes in HbA1c and SBP a year after diagnosis of diabetes through screening independently associate with new onset albuminuria four years later. Established multifactorial treatment for diabetes applies to cases identified through screening.