In order to evaluate the influence of glycemic control and hypertension on the development of diabetic nephropathy, we measured urinary excretion of albumin (AER) and other microproteins in non-insulin-dependent diabetes mellitus (NIDDM), and reexamined the 103 patients who had had AER < 300 μg/min at the initial study 12-18 months later. AER in the patients with HbA1c ≧ 7.5% increased significantly in both the normoalbuminuric (AER < 30 μg/min) and microalbuminuric (30-300 μg/min) groups, whereas no significant change in AER was observed in the patients with HbA1c < 7.5%. In the microalbuminuric group, AER in both hypertensive and normotensive patients increased significantly. In this group, the change in AER correlated positively with the change in α1-microglobulin (α 1M). These results indicate that glycemic control has a greater influence on the development of nephropathy in its early stage than hypertension and that α 1M is as a good predictor of nephropathy as albumin.
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