Borderline Increases in Albumin Excretion Rate and the Relation to Glycemic Control in Subjects with Type I Diabetes

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Abstract
We evaluated "borderline" increases in overnight albumin excretion rates (AERs)—i.e., those between the upper 95th percentile of normal (7.6 μg/min) and the lowest value currently considered predictive of nephropathy (30 μg/min)—to determine their importance and to see whether glucose control influenced subsequent changes in the "borderline" AER values. Between 1985 and 1990, we studied 190 subjects with insulin-dependent diabetes mellitus (Type I), analyzing a mean of 6.5 timed overnight urine samples collected per subject. Above-normal AERs were associated with a significantly (by ANOVA) higher mean age (P = 0.03), longer duration of diabetes (P = 0.0002), and greater mean glycohemoglobin values (P = 0.002). The transition rate between borderline and abnormal AERs was significantly higher (P<0.0001, chi-square test) than the direct transition rate between normal and abnormal AERs, thus showing the borderline AER to be a definite intermediate stage. Good and poor glucose control were clearly associated with improvement and worsening, respectively, of the borderline AER values (P = 0.032, chi-square test of trend). More attention to borderline AER values is clearly indicated.

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