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Higher Prevalence of Elevated Albumin Excretion in Youth With Type 2 Than Type 1 Diabetes

The SEARCH for Diabetes in Youth Study

¹ Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, Colorado
² Wake Forest University School of Medicine, Winston-Salem, North Carolina
³ Children’s Hospital Medical Center, Cincinnati, Ohio
⁴ University of Washington School of Medicine, Seattle, Washington
⁵ Centers for Disease Control and Prevention, Atlanta, Georgia
⁶ National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
⁷ University of South Carolina, Columbia, South Carolina
⁸ Sansum Diabetes Research Institute, Santa Barbara, California
⁹ Pacific Health Research Institute, Honolulu, Hawaii
¹⁰ Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado

Address correspondence and reprint requests to David Maahs, MD, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, P.O. Box 6511, Mail Stop A140, Aurora, CO 80045. E-mail: david.maahs{at}uchsc.edu

OBJECTIVE—To estimate the prevalence of an elevated albumin-to-creatinine ratio (ACR) (30 µg/mg) among youth with type 1 or type 2 diabetes and to identify factors associated with elevated ACR and their effect on the relationship between elevated ACR and type of diabetes.

RESEARCH DESIGN AND METHODS—Cross-sectional data were analyzed from 3,259 participants with onset of diabetes at <20 years of age in the SEARCH for Diabetes in Youth, a multicenter observational study of diabetes in youth. Multiple logistic regression was used to explore determinants of elevated ACR and factors accounting for differences in this prevalence between type 2 and type 1 diabetes.

RESULTS—The prevalence of elevated ACR was 9.2% in type 1 and 22.2% in type 2 diabetes (prevalence ratio 2.4 [95% CI 1.9–3.0]; P < 0.0001). In multiple logistic regression analysis, female sex, A1C and triglyceride values, hypertension, and type of diabetes (type 2 versus type 1) were significantly associated with elevated ACR. Adjustment for variables related to insulin resistance (obesity, hypertension, dyslipidemia, and inflammation) attenuated, but did not completely explain, the association of diabetes type with elevated ACR.

CONCLUSIONS—Youth with type 2 diabetes have a higher prevalence of elevated ACR than youth with type 1 diabetes, in an association that apparently does not completely depend on age, duration of diabetes, race/ethnicity, sex, level of glycemic control, or features of insulin resistance.

Abbreviations: ACR, albumin-to-creatinine ratio • CRP, C-reactive protein • IQR, interquartile range

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