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Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes

Effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex

¹ Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Berlin, Germany
² Department of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Leipzig, Germany
³ Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
⁴ Department of Pediatric Diabetology, Children's Hospital, Leverkusen, Germany
⁵ Children's Hospital, Klinikum Augsburg, Ausburg, Germany
⁶ Department of Internal Medicine II, SLK-Kliniken Heilbronn, Heilbronn, Germany
⁷ Department of Epidemiology, University of Ulm, Ulm, Germany

Address correspondence and reprint requests to Klemens Raile, MD, Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail: klemens.raile{at}charite.de

OBJECTIVE—To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease.

RESEARCH DESIGN AND METHODS—A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8–14.3]), age at last visit 16.34 years (12.5–22.2), and follow-up time 2.5 years (0.43–5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and association with risk factors by logistic regression.

RESULTS—Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78, and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% (95% CI 22.3–28.3) had microalbuminuria and 9.4% (8.3–11.4) had macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P < 0.0001), A1C (1.13, P < 0.0001), LDL cholesterol (1.003, P < 0.0074), and blood pressure (1.008, P < 0.0074), while childhood diabetes onset (1.011, P < 0.0001) was protective. Male sex was associated with the development of macroalbuminuria.

CONCLUSIONS—Diabetes duration, A1C, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes.

Abbreviations: AER, albumin excretion rate • DCCT, Diabetes Control and Complications Trial • DPV, German Diabetes Documentation System • ESRD, end-stage renal disease

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