Microalbuminuria as the best predictor of major complication outcomes in type 1 diabetes

The metabolic syndrome has been shown to confer an increased risk of CV disease in the general population and in subjects with type 2 diabetes. Few studies have assessed the metabolic syndrome in type 1 diabetes. To assess the value of the metabolic syndrome in improving the prediction of major diabetes complication outcomes compared to its components, 514 subjects participating in the Pittsburgh Epidemiology of Diabetes Complications Study with follow-up data for 12 years were classified by metabolic syndrome at baseline according to three definitions: NCEP ATP III, International Diabetes Federation (IDF) and World Health Organization (WHO). Diabetes complication outcomes included coronary artery disease, renal failure, diabetes-related death, and the aggregate of these three Major Outcomes of Diabetes (MOD). Whilst all definitions showed reasonable specificity (≥83%) for each outcome, the WHO definition had the highest sensitivity for all outcomes except for renal failure. Yet the components of each definition were better predictors of major diabetic complications than the overall syndrome, microalbuminuria being clearly the strongest predictor of all individual measures (HR for mortality: 9; HR for MOD: 6).

Abstract