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Natural History and Risk Factors for Microalbuminuria in Adolescents With Type 1 Diabetes

A longitudinal study

¹ Department of Endocrinology, Sydney Children’s Hospital, Randwick, Sydney, Australia
² School of Women’s and Children’s Health, The University of New South Wales, Sydney, Australia
³ Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead, Sydney, Australia
⁴ Department of Paediatrics and Child Health, The University of Sydney, Sydney, Australia

Address correspondence and reprint requests to Dr. Kim Donaghue, Paediatric Endocrinologist, Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Hawkesbury Road, Westmead, Sydney, Australia. E-mail:kimd{at}chw.edu.au

OBJECTIVE— To describe the natural history and risk factors for persistent microalbuminuria in children and adolescents with type 1 diabetes followed for up to 15 years.

RESEARCH DESIGN AND METHODS— This study contained a longitudinal cohort of 972 patients; analysis of baseline risk factors was performed using logistic regression and predictors over time using survival analysis. Albumin excretion rate was measured on three consecutive timed overnight urine collections on at least two occasions. Normoalbuminuria was defined as a median albumin excretion rate <7.5 µg/min, borderline microalbuminuria as 7.5–20 µg/min, and microalbuminuria as 20–200 µg/min. Microalbuminuria was further classified as persistent if its duration was >12 months. Median age was 12.7 years (interquartile range 11.5–14.4) and diabetes duration 6.5 years (4.1–9.3) at first assessment, and median follow-up was 6.2 years (range 1–15.3).

RESULTS— The incidence of persistent microalbuminuria was 4.6 (95% CI 3.3–6.1) per 1,000 patient-years. Predictors of persistent microalbuminuria from the first assessment using multiple logistic regression were high cholesterol (odds ratio 2.2 [95% CI 1.2–4.0]) and borderline microalbuminuria (2.5 [1.2–5.2]). Predictors using Cox regression were HbA_1c (hazard ratio 1.4 [95% CI 1.1–1.7]), age at diagnosis (1.2 [1.1–1.3]), obesity (3.6 [0.8–15.5]), and insulin dose (2.7 [1.0–7.5]).

CONCLUSIONS— Children and adolescents with type 1 diabetes who have borderline microalbuminuria are more than twice as likely to develop persistent microalbuminuria. In addition to poor glycemic control, clinical markers of insulin resistance were associated with an increased risk of microalbuminuria.

Abbreviations: AER, albumin excretion rate • DHEAS, dehydroepiandrosterone sulfate • SHBG, sex hormone–binding globulin

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