Dyslipidaemia and cardiovascular disease in non-insulin-dependent diabetic patient with and without diabetic nephropathy.

In 370 non-insulin-dependent diabetic (NIDDM) patients less than 66 years of age, we found the prevalence of albuminuria (> 300 mg 24 h-1) to be 13.8%. Males had a higher prevalence than females (19 vs. 5%). A kidney biopsy was performed in 35 patients. The biopsy revealed diabetic glomerulosclerosis in 77% of the cases and a variety of non-diabetic glomerulopathies in the remaining 23%. Fifty-six per cent of the patients with diabetic glomerulosclerosis had diabetic retinopathy, whereas none of the patients with non-diabetic glomerulopathies had signs of retinopathy. The presence of diabetic retinopathy strongly suggests that diabetic glomerulosclerosis is the cause of albuminuria. During a 5-year (range 1-7 years) prospective study, the course of kidney function was followed in 26 NIDDM patients with diabetic glomerulosclerosis. The glomerular filtration rate declined, and elevated systolic blood pressure was positively correlated to the rate of decline. The frequency of diabetic complications increased with increasing levels of urinary albumin excretion. In a cross-sectional study of 549 NIDDM patients, the prevalence of proliferative retinopathy was 2, 5 and 12%, the prevalence of hypertension 46, 68 and 85%, and the prevalence of ischaemic heart disease 22, 26 and 46% in normo-, micro-, and macroalbuminuria, respectively. The mortality from cardiovascular disease is increased ninefold in NIDDM patients with macroalbuminuria compared to the non-diabetic background population. The presence of the well-established risk factors cannot account for this finding alone.(ABSTRACT TRUNCATED AT 250 WORDS)