Microalbuminuria, glycemic control, and blood pressure predicting outcome in diabetes type 1 and type 2.

After years of controversy, there is no doubt that poor glycemic control is the main and fundamental basis for development of albuminuria and renal lesions in diabetes. Blood pressure elevation usually comes secondarily, at least in type 1 diabetes, but in type 2 diabetes, microalbuminuria and some blood pressure elevation may be present already with the diagnosis of diabetes, along with dyslipidemia. Genetic factors have been proposed to be important, and so far, analysis of genotypes has no place in clinical practice [1–3]. In many studies, microalbuminuria along with blood pressure elevation, even minor, is crucial to the later outcome of patients, and also regarding strategy for treatment. When microalbuminuria is found along with increased blood pressure, the prognosis is even poorer than with only one of these abnormalities present in the patients. Indeed, high blood pressure may be part of the family history of some patients and, therefore, again emerging as a familiar risk factor, although only relevant to few patients.