[Significance of proteinuria and hypertension in the prognosis of type 1 diabetes. Results of a 10-year follow-up study on micro- and macrovascular disease mortality]

Among 163 insulin-dependent (type I) diabetics (average age 43.5 years; average duration of diabetes 17.5 years), 40 (24.5%) died within ten years from the consequences of micro- and (or) macro-angiopathies. The death-rate among hypertensives was twice that among normotensives: 21 of 53 patients (39.6%) with blood pressures above 160/95 mmHg, but 19 of 110 patients (17.3%) with normal pressures. Proliferative retinopathy at the onset of the study was also a predictive marker of a poor prognosis. The death-rate increased threefold for patients with retinopathy if they also had hypertension: 13 of 30 (43.3%) with background retinopathy and hypertension died, compared with 9 of 68 without hypertension (13.2%; P less than 0.01). Independently of hypertension the death-rate for patients with persistent proteinuria (greater than 0.5 g/24 h) was about threefold that among those without it. The highest death-rate (56.7%) was among the 30 patients with proteinuria and hypertension. Stepwise linear regression analysis demonstrated that the correlation between death from micro- and macro-vascular disease and the known risk factors was entirely determined by blood pressure and proteinuria.