For men higher levels of the protein albumin in the urine are a strong risk factor for diabetes, reports a study in the November 2008 issue of the Journal of Hypertension.

For men, but not women, higher levels of the protein albumin in the urine are a strong risk factor for diabetes, reports a study in the November 2008 issue of the Journal of Hypertension. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Men's risk of diabetes rises steadily along with urinary albumin excretion (UAE) level, independent of other diabetes risk factors, the researchers conclude. The lead author was Dr. Jean-Michel Halimi of François Rabelais University, Tours, France.

The study included 3,851 men and women from an ongoing study of risk factors for insulin resistance syndrome, a pre-diabetic state. The subjects, aged 30 to 64 years, underwent measurement of UAE. Increased UAE levels, or microalbuminuria, are a key early sign of kidney disease-often caused by diabetes. Microalbuminuria is defined as a UAE between 20 and 200 mg/L (milligrams per litre).

The subjects were also evaluated for the five risk factors that make up the  metabolic syndrome: elevated waist circumference, high triglyceride level, low HDL ("good") cholesterol level, high blood pressure, and high glucose level. People with any three of these risk factors are considered to have metabolic syndrome, which is linked to an increased risk of cardiovascular disease and diabetes. People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes. People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome

As Albumin Excretion Increases, So Does Men's Diabetes Risk

During nine years' follow-up, diabetes developed in 171 subjects (132 men and 39 women). For men, the risk of diabetes increased steadily along with UAE. Diabetes risk was approximately doubled for men with UAE levels meeting the definition of microalbuminuria. For men with UAE levels over the 200 mg/L cut-off point for "macroalbuminuria"-indicating established kidney disease-the risk of diabetes was more than quadrupled.

For women, UAE was not a significant risk factor for diabetes.

The link between UAE and diabetes was even stronger after exclusion of men who had abnormal glucose levels at the beginning of the study. It also remained significant after adjustment for a wide range of other risk factors, including body weight, physical activity, smoking, and waist circumference; and for the development of insulin resistance during the first three years of follow-up.

Type 2 diabetes usually causes no symptoms in its early stages, and can go undiagnosed for years before serious complications occur. New approaches are needed to identifying patients at increased risk of diabetes, who may benefit from preventive measures. Patients with insulin resistance or metabolic syndrome are more likely to have elevated UAE. However, the relationship between UAE and the development of diabetes-with or without metabolic syndrome-has been unclear.

"UAE is a potent independent predictive marker of diabetes mellitus in men but not in women," Dr. Halimi and colleagues write. For men, diabetes risk rises steadily along with UAE level, independent of several major diabetes risk factors. The reasons for this relationship are unknown, although many interrelated factors may be involved.

"In conclusion, our findings indicate that albuminuria may improve the identification of men at risk of diabetes mellitus, beyond the presence of metabolic syndrome," Dr. Halimi and colleagues conclude. Measuring UAE may provide a simple new test to assess diabetes risk. The next step is studies to find out whether treatments to lower urine albumin can help to reduce the risk of diabetes.

About Type 2 Diabetes

Type 2 diabetes is also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). Type 2 diabetes affects nearly 21 million in the United States and nearly 200 million people worldwide.

Type 2 diabetes is characterized by high levels of blood sugar, caused by the body's inability to utilize insulin to move blood sugar into the cells for energy. In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance as discussed above. In many cases this actually means the pancreas produces larger than normal quantities of insulin.

Diabetes is a major cause of heart disease and stroke, as well as the most common cause of blindness, kidney failure and amputations in U.S. adults. 

About Metabolic Syndrome

• Heart disease
• Stroke
• Type 2 diabetes 

All of these conditions are associated with high blood insulin levels. The fundamental defect in the metabolic syndrome is insulin resistance in both adipose tissue and muscle. Drugs that decrease insulin resistance also usually lower blood pressure and improve the lipid profile.

A person is considered having metabolic syndrome if they have any three of the following five conditions: 

• High blood pressure (hypertension). >130 mm hg / 35 mm hg
• Abnormal level of fasting blood glucose. > 100 mg/dl (or prediabetes which is between 100 - 125 mg/dl)
• Increased weight around the waist. (apple shape rather than pear shape). Typically a waist measurement (apple shaped) >35" for women, > 40 " for man.
• Elevated triglycerides. > 150 mg/dl
• Low HDL ("good") cholesterol. <40 mg/dl men, < 50 mg/dl

People with metabolic syndrome also have a five-fold greater risk of developing type 2 diabetes. This puts a person with metabolic syndrome at great risk for ultimately dying from cardiovascular disease. 

About Journal of Hypertension

Journal of Hypertension (www.jhypertension.com) consistently attracts the most important and highly innovative papers from the current research; our commitment to rapid publication ensures that these are published in the fastest time possible. In addition to primary papers from world-renowned experts, the Journal contains authoritative reviews that summarize and evaluate the most significant recent developments. Also included are special reports, original short papers containing innovative and time-sensitive information. Journal of Hypertension is official journal of the International Society of Hypertension and the European Society of Hypertension.

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