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array:23 [ "pii" => "S1575092211000623" "issn" => "15750922" "doi" => "10.1016/j.endonu.2011.01.006" "estado" => "S300" "fechaPublicacion" => "2011-04-01" "aid" => "190" "copyright" => "SEEN" "copyrightAnyo" => "2010" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2011;58:163-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 7019 "formatos" => array:3 [ "EPUB" => 22 "HTML" => 6315 "PDF" => 682 ] ] "itemSiguiente" => array:18 [ "pii" => "S1575092211000908" "issn" => "15750922" "doi" => "10.1016/j.endonu.2011.02.005" "estado" => "S300" "fechaPublicacion" => "2011-04-01" "aid" => "202" "copyright" => "SEEN" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2011;58:169-74" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 7449 "formatos" => array:3 [ "EPUB" => 20 "HTML" => 6447 "PDF" => 982 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "El entrenamiento con pesas mejora la sensibilidad a la insulina y los niveles plasmáticos de lípidos, sin alterar la composición corporal en sujetos con sobrepeso y obesidad" "tienePdf" => array:2 [ 0 => "es" 1 => "en" ] "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "169" "paginaFinal" => "174" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Strength training improves insulin sensitivity and plasma lipid levels without altering body composition in overweight and obese subjects" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:2 [ "es" => true "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1965 "Ancho" => 2333 "Tamanyo" => 237440 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Somatotipo, carta y distancia somatotipica (coordenadas X y Y) por grupos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Óscar Hernán Jiménez, Robinson Ramírez-Vélez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Óscar" "apellidos" => "Hernán Jiménez" ] 1 => array:2 [ "nombre" => "Robinson" "apellidos" => "Ramírez-Vélez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092211000908?idApp=UINPBA00004N" "url" => "/15750922/0000005800000004/v1_201305082242/S1575092211000908/v1_201305082242/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1575092211000635" "issn" => "15750922" "doi" => "10.1016/j.endonu.2011.01.007" "estado" => "S300" "fechaPublicacion" => "2011-04-01" "aid" => "191" "copyright" => "SEEN" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2011;58:157-62" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 17357 "formatos" => array:3 [ "EPUB" => 20 "HTML" => 16014 "PDF" => 1323 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Carcinoma diferenciado de tiroides: supervivencia y factores relacionados" "tienePdf" => array:2 [ 0 => "es" 1 => "en" ] "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "162" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Differentiated thyroid carcinoma: survival and prognostic factors" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:2 [ "es" => true "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1858 "Ancho" => 2478 "Tamanyo" => 171380 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Probabilidad de supervivencia según estadio AJCC 6ª edición, al diagnóstico. 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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cristina" "apellidos" => "Fernández Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Inmaculada" "apellidos" => "Moreno Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Carlos" "apellidos" => "de Gorospe Pérez-Jáuregui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Belén" "apellidos" => "Silveira Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Tomás" "apellidos" => "González Losada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Amparo" "apellidos" => "Segura Galindo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Section of Endocrinology and Nutrition, Hospital Universitario Infanta Leonor, School of Medicine, Universidad Complutense, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Preventive Medicine, Hospital Clínico Universitario, School of Medicine, Universidad Complutense, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones microvasculares y factores de riesgo en pacientes con diabetes mellitus tipo 2" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetic nephropathy has a cumulative prevalence of 30%-40% in patients with type 2 diabetes mellitus (T2DM) and is currently the leading cause of end-stage renal disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are several markers predicting for the risk of developing renal failure in T2DM patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, microalbuminuria remains the main and most widely used marker of diabetic renal damage in clinical practice. It is also a marker of organ dysfunction, and has been shown to be associated with an increased risk of cardiovascular morbidity and mortality in T2DM patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The earliest clinical evidence of nephropathy is occurrence of abnormal urinary albumin levels (30-300<span class="elsevierStyleHsp" style=""></span>mg/day), referred to as microalbuminuria. The finding of microalbuminuria is a signal for screening for potential vascular disease and aggressive intervention to reduce all cardiovascular risk factors.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diabetic retinopathy is the most common microvascular complication in diabetes, and may lead to severe vision loss.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Retinopathy lesions (microaneurysm, hemorrhage, cotton wool spots, hard exudates) may reliably be detected using direct ophthalmoscopy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> People with diabetes should have regular fundus examinations to timely detect sight-threatening retinopathy lesions. Presence of retinopathy not only involves an increased risk of vision loss, but also a two to three-fold excess risk of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Microalbuminuria is associated with diabetic retinopathy in patients with T2DM and is a reliable marker of retinopathy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Moreover, the presence of diabetic retinopathy at baseline is associated with increased proteinuria, lower glomerular filtration rate (GFR), and a higher risk for end-stage renal disease and death in patients with T2DM.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several risk factors such as poor glycemic control, dyslipidemia, hypertension, obesity, and cigarette smoking act synergistically to develop nephropathy and retinopathy in patients with T2DM.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> Since progression to microvascular complications is likely to occur in a significant proportion of diabetic patients, the role of these risk factors needs to be further explored.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our aim was to conduct a prospective study in T2DM patients with no microvascular complications (nephropathy and retinopathy), analyzing the association between a variety of baseline risk factors and occurrence of microvascular complications at follow-up.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study population and design</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">A</span> prospective, observational study was conducted at Montes de Barbanza public health center, a specialized secondary referral center covering the 31 urban district of Madrid, Spain. Three hundred and seventy-six patients with T2DM aged ≥18<span class="elsevierStyleHsp" style=""></span>years were enrolled in 2004. Inclusion criteria were normal urinary albumin levels (<30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h) and absence of retinopathy (as assessed by funduscopy) at baseline. Exclusion criteria included type 1 diabetes mellitus, diabetic nephropathy (urinary albumin excretion [UAE] >30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, or plasma creatinine above normal reference values) and/or retinopathy at baseline.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical end-point was a UAE level >30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and/or the presence of retinopathy at follow-up in 2007. Mean study period was 3.5<span class="elsevierStyleHsp" style=""></span>years.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Subjects provided written informed consent. The study was approved by the local ethics committee and conducted in accordance with the principles described in the Declaration of Helsinki.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical examination and biochemistry</span><p id="par0045" class="elsevierStylePara elsevierViewall">The following variables were collected from the medical records of patients at baseline, in 2004: age, gender, diabetes duration, fasting plasma glucose (FPG), glycated hemoglobin (HbA<span class="elsevierStyleInf">1c</span>), systolic (SBP) and diastolic blood pressure (DBP), body weight, height, body mass index (BMI), waist circumference (WC), total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), high sensitive C-reactive protein (hs-CRP), fibrinogen, UAE, creatinine, smoking status, exercise, alcohol consumption, use of hypoglycemic and lipid-lowering drugs, antihypertensive medications, and other data related to family history of diabetes and its risk factors.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patient weight and height were measured to the nearest 0.1<span class="elsevierStyleHsp" style=""></span>kg and 0.1<span class="elsevierStyleHsp" style=""></span>cm respectively. BMI was calculated as weight divided by height squared (kg/m<span class="elsevierStyleSup">2</span>). WC was recorded, according to Ashwell et al.,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> as the smallest girth between the rib cage and the iliac crest (it was located cranial to the umbilicus). A smoker was defined as someone consuming ≥ one cigarette/day or the equivalent using a pipe, or someone who had stopped smoking within 3 months of recruitment. Subjects were considered to practice exercise if they spent more than 3<span class="elsevierStyleHsp" style=""></span>hours weekly walking or doing any other exercise or sports.</p><p id="par0055" class="elsevierStylePara elsevierViewall">SBP and DBP were measured in all subjects after a 10-minute rest using a standard brachial cuff technique. Hypertension was defined as the need for antihypertensive therapy or untreated patients with SBP ≥ 130<span class="elsevierStyleHsp" style=""></span>mmHg and/or DBP ≥ 80<span class="elsevierStyleHsp" style=""></span>mmHg. Nephropathy was diagnosed if UAE levels > 30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h were found in two of three urine samples taken during a three to six-month period. An Advira 2400 device (Siemens) was used to measure UAE by chemiluminescence.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ophthalmoscopic examination was performed in all patients by two experienced ophthalmologists from our clinic by funduscopy (using slit lamp and contact lenses) and indirect ophthalmoscopy. If required, fluorescein angiography was performed. Retinopathy was diagnosed by the presence of any of the following lesions: microaneurysm, blot or flame-shaped hemorrhage, hard exudates, cotton wool spots, or evidence of laser treatment for retinopathy.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Biochemical parameters were measured after an overnight fast. FPG was measured by a glucose oxidase method. HbA<span class="elsevierStyleInf">1c</span> was tested by high-performance liquid chromatography (reference range, 3.5% to 6.5%). Fibrinogen was measured by Clauss-Assay coagulometry (HORIBA ABX, Spain), and hs-CRP using a Vitros Chemistry System 5.1 FS analyzer (Ortho-Clinical Diagnostics, Johnson & Johnson, Madrid, Spain). HDL-C and TG were tested by enzymatic methods, and LDL-C was calculated using the Friedewald equation.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients requiring lipid-lowering therapy or untreated patients with total cholesterol > 5.0 mmol/L and/or TG > 1.7 mmol/L were considered to have dyslipidemia. Dyslipidemia phenotypes were defined as IIa: hypercholesterolemia, IIb: hypertriglyceridemia and IV: hypercholesterolemia + hypertriglyceridemia.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Based on the recommendations for adults with diabetes mellitus from the American Diabetes Association (ADA),<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> the following were considered as acceptable target values: HbA<span class="elsevierStyleInf">1c</span> <7.0%, FPG <7.2 mmol/L, HDL-C >1.1 mmol/L, LDL-C <2.6 mmol/L, TG <1.7 mmol/L, SBP <130<span class="elsevierStyleHsp" style=""></span>mmHg, DBP <80<span class="elsevierStyleHsp" style=""></span>mmHg, BMI <25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, and current non-smoking status. In addition, according to the WC cut-off points proposed by the World Health Organization as indicators of cardiovascular risk,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> WC measurements of <88<span class="elsevierStyleHsp" style=""></span>cm in women and <102<span class="elsevierStyleHsp" style=""></span>cm in men were considered as goals of body fat distribution.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">A Student’s t test for unpaired samples was used to compare mean levels with standard deviations (SD), and a Chi-square to compare proportions. A receiving operating characteristic (ROC) curve was performed and UAE sensitivity and specificity were calculated. The area under the ROC curve and 95% confidence interval (CI) were calculated. In addition, the optimum cut-off point of UAE for predicting microvascular complications during the follow-up period was sought. The optimum cut-off point was defined as the point on the ROC curve closest to the point (0, 1), i.e. a false positive rate of zero and a 100% sensitivity.</p><p id="par0085" class="elsevierStylePara elsevierViewall">A value of hs-CRP > 3<span class="elsevierStyleHsp" style=""></span>mg/L was chosen as the optimum cut-off point because hs-CRP levels > 3<span class="elsevierStyleHsp" style=""></span>mg/L are associated to a high cardiovascular risk.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Logistic regression analyses were performed with development of nephropathy and/or retinopathy at follow up as dependent variables, and age, gender, diabetes duration, hypertension, hs-CRP >3<span class="elsevierStyleHsp" style=""></span>mg/L, WC, BMI, SBP, UAE >12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, and other risk factors included at baseline as independent variables.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Odds ratios (OR) were estimated, with an OR >1.0 denoting a positive association. A value of <span class="elsevierStyleItalic">P</span><.05 was considered statistically significant. All statistical analyses were performed using the SPSS for Windows statistical software package (version 13.0, Chicago, SPSS Inc.).</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">During 2004, 376 patients were recruited into the study. Ninety-five (25.2%) of these patients developed a microvascular complication at follow-up (77 nephropathy and 44 retinopathy). Twenty-six of them developed both retinopathy and nephropathy. No differential features were seen between the groups which developed retinopathy or nephropathy only and those developing both retinopathy and nephropathy. As compared to patients who did not develop microvascular complications at follow-up, those with such complications were predominantly male (<span class="elsevierStyleItalic">P</span><.05), tended to be older (<span class="elsevierStyleItalic">P</span><.05), to have higher hypertension rates (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.008), hs-CRP levels >3<span class="elsevierStyleHsp" style=""></span>mg/L (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.007), to be taking more insulin (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.000), and to receive less frequently oral hypoglycemic agents (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.003). They were also more likely to have a longer mean diabetes duration and higher WC, SBP, DBP, creatinine, microalbuminuria, and hs-CRP values (<span class="elsevierStyleItalic">P</span><.05 for all). The area under the ROC curve for microalbuminuria was 0.653<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.041 (<span class="elsevierStyleItalic">P</span><.001), and the cut-off point for microalbuminuria with 67% sensitivity and 63% specificity was 12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows clinical and biochemical data for patients with T2DM who had no nephropathy and retinopathy at baseline in 2004, and classifies them into those who progressed to microvascular complications and those with no progression to complications at follow-up in 2007.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In the logistic regression analyses of baseline risk factors for development of microvascular complications at follow-up, the main independent risk factors were urinary albumin excretion > 12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h (OR: 6.12; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.000), hs-CRP> 3<span class="elsevierStyleHsp" style=""></span>mg/L (OR: 3.00; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.004), and hypertension (OR: 2.43; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.023) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">In agreement with findings by other authors,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16–19</span></a> in our study, baseline levels of UAE >12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and hs-CRP >3<span class="elsevierStyleHsp" style=""></span>mg./L and the presence of hypertension were exceedingly strong independent risk factors for development of nephropathy and/or retinopathy in 376 patients with T2DM.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Several prospective and observational studies conducted on normoalbuminuric type 1 and type 2 diabetics followed up for long periods of time (between 5 and 10<span class="elsevierStyleHsp" style=""></span>years) have found that several potentially modifiable risk factors, such as smoking, poor glycemic control, and UAE predict for the development of incipient and overt diabetic nephropathy<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>; duration of diabetes, abnormal HbA<span class="elsevierStyleInf">1c</span> levels, hypertension, and high serum creatinine levels were significantly associated to microalbuminuria, and duration of diabetes, HbA<span class="elsevierStyleInf">1c</span>, hypertension, and retinopathy were independent variables related to microalbuminuria<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>; total cholesterol levels, mean blood pressure, and HbA<span class="elsevierStyleInf">1c</span> were the main factors associated with a decreased renal function and increased albuminuria<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>; and finally, increased baseline urinary albumin excretion rate, male sex, presence of retinopathy, increased serum cholesterol levels, HbA<span class="elsevierStyleInf">1c</span> concentration, and age were risk factors for the development of incipient or overt diabetic nephropathy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Our findings confirm known predictive factors, such as UAE<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,19</span></a> and hypertension,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> for the development of nephropathy in patients with type 2 diabetes. UAE is an independent risk factor for diabetic retinopathy in elderly type 2 diabetics.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Cross-sectional studies in patients with T2DM have found microalbuminuria to be associated with diabetic retinopathy and to be a reliable marker of retinopathy<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>; diabetic maculopathy is closely associated with diabetic nephropathy and with several atherosclerotic risk factors, suggesting that these factors could have a significant role in the pathogenesis of maculopathy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Moreover, the presence of diabetic retinopathy at baseline in 1513 patients with T2DM and nephropathy was associated with increased proteinuria, lower GFR, and a higher risk for end-stage renal disease and death; these factors appeared to be independent from arterial blood pressure, glycemic control, hypercholesterolemia, and ethnicity.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These data suggest that microalbuminuria may be a marker for the risk of development of proliferative retinopathy.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study suggests that UAE levels >12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h are the most significant independent risk factor for development of nephropathy and/or retinopathy in the T2DM patients studied. However, according to current guidelines, the UAE cut-off level for progression to nephropathy is 30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In this study, hs-PCR levels > 3<span class="elsevierStyleHsp" style=""></span>mg/L were an independent risk factor for development not only of diabetic nephropathy, but also of diabetic retinopathy. Inflammatory markers in early diabetic nephropathy in patients with type 2 diabetes are elevated and are independently associated with UAE. It may be hypothesized that released pro-inflammatory cytokines may participate in occurrence of kidney damage.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Increased levels of sialic acid, a marker of inflammation, in serum and microalbumin were strongly related to the presence of microvascular complications such as diabetic nephropathy and retinopathy and some cardiovascular risk factors, such as hypertension and high waist to hip ratios, in Caribbean type 2 diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The frequency of hs-CRP values higher than 1.0<span class="elsevierStyleHsp" style=""></span>mg/L, which are thought to involve at high risk for cardiovascular disease, was also high in subjects with complicating hypertension and low in diabetic patients with retinopathy.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> On the other hand, fibrinogen might be more closely associated with diabetic microangiopathy than hs-CRP.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Inflammatory parameters in T2DM patients with early stage nephropathy are independently associated with UAE.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Elevated hs-CRP levels enhance the relationship between blood pressure (which has been shown to be the main determinant of microalbuminuria in diabetes and hypertension) and microalbuminuria. This interaction was found independently of other factors.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> It has been suggested that hs-CRP may be a marker of vascular disease, which indicates impaired self-regulation of glomerular pressure and/or dysfunction of glomerular endothelium. Both these factors may increase microalbuminuria.</p><p id="par0140" class="elsevierStylePara elsevierViewall">This prospective study also showed hypertension to be an independent baseline risk factor for development of nephropathy, as previously reported by less extensive studies.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> Hypertension is a well known risk factor for development of kidney disease.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Microalbuminuria is also associated with early renal damage due to hypertension. In the HOPE study,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> an association was found between hypertension and microalbuminuria in diabetic patients. High blood pressure is a significant marker for progression from microalbuminuria to nephropathy.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Recent data have shown that an improved blood pressure control is beneficial to reduce the incidence of macular edema<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> and suggest that renin-angiotensin system blockers might reduce the incidence of diabetic retinopathy.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion, UAE levels >12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, hs-CRP levels >3<span class="elsevierStyleHsp" style=""></span>mg/L, and hypertension were all independent risk factors for development of nephropathy and/or retinopathy in the T2DM patients studied. Decreases in levels of these risk factors in patients with T2DM without microvascular complications may prevent nephropathy and/or retinopathy. Further studies in similar populations are needed to confirm our results.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">Cristina Fernández Pérez has acted as a scientific advisor or consultant for Merck Sharp & Dohme, S.A., Spain.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres148166" "titulo" => array:5 [ 0 => "Abstract" 1 => "Aim" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec136057" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres148165" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec136056" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population and design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical examination and biochemistry" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack41905" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-09-08" "fechaAceptado" => "2011-01-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec136057" "palabras" => array:5 [ 0 => "Type 2 diabetes mellitus" 1 => "Microvascular complications" 2 => "Cardiovascular risk factors" 3 => "Diabetic nephropathy" 4 => "Diabetic retinopathy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec136056" "palabras" => array:5 [ 0 => "Diabetes mellitus tipo 2" 1 => "Complicaciones microvasculares" 2 => "Factores de riesgo cardiovascular" 3 => "Nefropatía diabética" 4 => "Retinopatía diabética" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To conduct a prospective study in patients with type 2 diabetes mellitus (T2DM) with no microvascular complications, analyzing the association between various baseline risk factors and development of microvascular complications at follow-up.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective, observational study in 376 patients with T2DM enrolled in 2004. The clinical end-point was urinary albumin excretion (UAE) > 30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and/or presence of retinopathy at follow-up in 2007. Baseline variables included age, gender, duration of T2DM, fasting plasma glucose, glycated hemoglobin (HbA<span class="elsevierStyleInf">1c</span>), systolic and diastolic blood pressure, body weight, height, body mass index, waist circumference, total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitive C-reactive protein (hs-CRP), fibrinogen, UAE, creatinine, smoking status, exercise, alcohol consumption, use of hypoglycemic and lipid-lowering drugs, antihypertensive medications, and other data related to family history of diabetes and risk factors.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ninety-five subjects (25.2%) developed a microvascular complication at the end of the follow-up period. In logistic regression analyses, the main independent risk factors were UAE >12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h (odds ratio [OR]: 6.12; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.000), hs-CRP> 3<span class="elsevierStyleHsp" style=""></span>mg/L (OR: 3.00; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.004), and hypertension (OR: 2.43; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.023).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">UAE levels higher than 12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, hs-CRP >3<span class="elsevierStyleHsp" style=""></span>mg/L, and presence of hypertension were all independent risk factors for development of microvascular complications in patients with T2DM studied.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Realizar un estudio prospectivo en sujetos con diabetes mellitus tipo 2 (DM2) sin complicaciones microvasculares, analizando la asociación entre varios factores de riesgo al inicio y el desarrollo de complicaciones microvasculares durante el seguimiento.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo, observacional en 376 sujetos con DM2 incluidos en 2004. El objetivo clínico final fue la excreción urinaria de albúmina (EUA) > 30<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h y/o presencia de retinopatía al final del seguimiento en 2007. Basalmente las variables fueron: edad, sexo, duración de la diabetes, glucosa plasmática en ayunas, hemoglobina glucada (HbA<span class="elsevierStyleInf">1c</span>), presión arterial sistólica y diastólica, peso, talla, índice de masa corporal, circunferencia de la cintura, colesterol total, triglicéridos, colesterol unido a lipoproteína de alta densidad (c-HDL), colesterol unido a lipoproteína de baja densidad (c-LDL), proteína C reactiva de alta sensibilidad (PCR-as), fibrinógeno, EUA, creatinina, tabaquismo, ejercicio, consumo de alcohol, utilización de medicación hipoglucemiante, hipolipemiante e hipotensora, y otros datos relacionados con los antecedentes familiares de diabetes y factores de riesgo.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Al final del seguimiento 95 sujetos (25,2%) desarrollaron una complicación microvascular. En el análisis de regresión logística, los principales factores de riesgo independientes fueron la EUA > 12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h (odds ratio [OR]: 6,12; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,000), la PCR-as > 3<span class="elsevierStyleHsp" style=""></span>mg/l (OR: 3,00; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,004) y la hipertensión (OR: 2,43; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,023).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los niveles de EUA superiores a 12<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, la PCR-as > 3<span class="elsevierStyleHsp" style=""></span>mg/l y la presencia de hipertensión fueron factores de riesgo independientes para el desarrollo de complicaciones microvasculares en los sujetos con DM2 estudiados.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DBP: diastolic blood pressure; hs-CRP: high sensitive C-reactive protein; OHA: oral hypoglycemic agents; SBP: systolic blood pressure; UAE: urinary albumin excretion.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parameters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">With microvascular event at follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Without microvascular event at follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>281 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.7<span class="elsevierStyleItalic">/</span>19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.3<span class="elsevierStyleItalic">/</span>80.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension (yes<span class="elsevierStyleItalic">/</span>no, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.7<span class="elsevierStyleItalic">/</span>11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.3<span class="elsevierStyleItalic">/</span>88.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">hs-CRP (< 3 mg/l<span class="elsevierStyleItalic">/</span>≥3 mg/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.6<span class="elsevierStyleItalic">/</span>28.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.4<span class="elsevierStyleItalic">/</span>71.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypoglicemic drugs (Insulin<span class="elsevierStyleItalic">/</span>OHA; %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.8<span class="elsevierStyleItalic">/</span>16.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.2<span class="elsevierStyleItalic">/</span>83.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OHA (yes<span class="elsevierStyleItalic">/</span>no; %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.2<span class="elsevierStyleItalic">/</span>33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.8<span class="elsevierStyleItalic">/</span>66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes duration (years)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waist Circumference (cm)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP (mmHg)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DBP (mmHg)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">hs-CRP (mg/l)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinin (μmol/l)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UAE (mg/24 h)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab242143.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prospective study, 2004-2007: clinical and biochemical data of type 2 diabetic subjects without nephropathy and retinopathy at baseline in 2004, classified as those who progressed to microvascular complications and those who did not progress to complications at follow-up, in 2007.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Independent variables in 2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Dependent variable: Microvascular complications at follow-up (odds ratio [95% CI]) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.52 (0.48-4.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.02 (0.96-4.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.065 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80 (0.37-1.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.43 (1.13-5.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High sensitive C-reactive protein > 3 mg/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00 (1.41-6.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waist circumference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 (0.94-1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (0.86-1.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systolic blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 (0.98-1.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antihypertensive therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.12 (0.36-3.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microalbuminuria > 12 mg/24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.12 (2.94-12.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n 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