Abstract
Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.
Highlights
Microalbuminuria is an early predictor of the renal, cardiovascular and retinopathy complications of diabetes [1,2,3,4,5]
The American Diabetes Association (ADA) recommends that a standard screening test for microalbuminuria should be used at diagnosis and at least yearly thereafter in type 2 diabetes [6]
Eligible subjects of the derivation set were type 2 diabetic patients aged ≥18 years and without a history of nephropathy and/or renal failure who attended the outpatient at diabetes clinic of each hospital between January and December 2009. 225 type 2 diabetic subjects with microalbuminuria were cases group and 225 type 2 diabetic subjects with normoalbuminuria were controls group diagnosed by radioimmunoassay or Micral test
Summary
Microalbuminuria is an early predictor of the renal, cardiovascular and retinopathy complications of diabetes [1,2,3,4,5]. In Thailand, around 41.0% of type 2 diabetes patients in tertiary care units were not screened for microalbuminuria [8]. Qualitative methods can be used to screen for microalbuminuria; these are more readily available for use in the clinic, less complicated and cheaper than quantitative assessments but they are less accurate and less specific [9]. Both methods required three urine specimens collection within twelve months period and obtained on different days. These are not convenient for patients and they may be unable or unwilling to have the test performed
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