[Evaluation of retinal involvement in type 2 diabetics with microalbuminuria]

Abstract

Background: In patients with type 2 diabetes, the presence of microalbuminuria, reflecting a widespread vascular damage, can be a marker of nephropathy, retinophaty and cardiovascular diseases.

Aim: To study the relationship between microalbuminuria and the frequency, severity and outcome of retinopathy in patients with type 2 diabetes mellitus.

Patients and methods: One hundred patients with type 2 diabetes were subjected to a clinical examination, serial monitoring of blood pressure and quarterly measurement of microalbuminuria by RIA. Annually, a fundoscopy, a color photography of the posterior pole and retinal angiofluorescence were performed. Retinopathy was classified as basal (mild to moderate), preproliferative and proliferative. Sixty-four normoalbuminuric patients (urinary albumin of less than 30 mg/24 h) were included in group 1 and 36 patients with a urinary albumin over 30 mg/24 h in group 2. Fifty seven patients with normal blood pressure were randomly treated with enalapril or placebo and those with hypertension received enalapril or acebutolol to normalize blood pressure.

Results: Sixty one percent of group 1 patients and 41% of group 2 patients has retinopathy (p < 0.05). The retinal lesions were proliferative in 41% of group 2 patients and in 8% of group 1 patient (p < 0.05). Retinopathy was present in 67% of hypertensive patients of group 2 and in 41% of hypertensive patients of group 1. An unfavorable evolution of retinopathy was observed in 22% of group 2 patients and in 5% of group 1 patient (p < 0.05).

Conclusions: In type 2 diabetic patients, the presence of microalbuminuria is a prediction of a higher frequency, severity and dismal evolution of diabetic retinopathy (Rev Méd Chile 2000; 128: 1085-92).