Abstract

Objective: To investigate the prevalence of albuminuria (microalbuminuria and macroalbuminuria) in patients with type 2 diabetes mellitus (DM) attending the National Center of Diabetes, Endocrinology, and Genetics (NCDEG) in Jordan. The second objective of the study was to determine if there is any association between albuminuria (microalbuminuria and macroalbuminuria) and a number of independent variables, including glycemic control, hypertension, duration of diabetes mellitus, serum lipids, body mass index, smoking, age, gender and the presence of retinopathy.
Methods: A cross-sectional study was carried out at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), Jordan. A total of 869 diabetic patients aged 30 years and above with type 2 diabetes mellitus who attended the clinic from 1st September 2007 through 10th January 2008 were included. At least two out of three random morning spot urine samples were collected in a three-month period to determine the urinary albumin-creatinine ratio (ACR). Microalbuminuria is defined as an ACR of 30-299 mg/g and macroalbuminuria is defined as an ACR >300 mg/g according to the definition proposed by the American Diabetes Association (ADA). Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS, version 11.5).
Results: Out of the 880 patients recruited, 5 (0.6%) were excluded due to the presence of urinary tract infections and 6 (0.7%) for the presence of congestive heart failure, leaving 869 patients for evaluation. There were 56.0% male and44% female. The mean age and duration of diabetes were 57.8 years and 9.5 years, respectively. Approximately 62% were being managed by oral hypoglycemic agents alone, 4.3% by insulin alone, 31.7% were on a combination of oral hypoglycemic agents and insulin and slightly less than 2% were on dietary measures alone. The mean value for HbA1c was 7.71%. The overall prevalence of  albuminuria among participants was found to be 34.6%; microalbuminuria (29.3%) and macroalbuminuria (5.3%). Multivariate logistic regression analysis identified HbA1c, SBP, DBP and the presence of retinopathy as independent risk factors for microalbuminuria and SBP. Male gender and presence of retinopathy were identified as independent risk factors for macroalbuminuria.
Conclusion: Albuminuria is highly prevalent among Jordanians with type 2 diabetes. This calls for early and universal screening of urinary albumin. There is also an urgent need for measures that target tight glycemic and optimal blood pressure control and the use of renin-angiotensin system blockade.

Keywords: diabetes mellitus; microalbuminuria; macroalbuminuria; Jordan