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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

¹Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, CO
²Wake Forest University School of Medicine, Winston-Salem, NC
³Children's Hospital Medical Center, Cincinnati, OH
⁴University of Washington School of Medicine, Seattle, WA
⁵Centers for Disease Control and Prevention, Atlanta, GA
⁶National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
⁷University of South Carolina, Columbia, SC
⁸Sansum Diabetes Research Institute, Santa Barbara, CA
⁹Pacific Health Research Institute, Honolulu, HI
¹⁰Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO

David.Maahs{at}uchsc.edu

ABSTRACT

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 mellitus, 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 3259 participants with onset of diabetes at <20 years of age in 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 (prevalence ratio, 2.4; 95% confidence interval, 1.9-3.0; P<0.0001). In multiple logistic regression analysis, female sex, HbA1c and triglyceride values, hypertension, and type of diabetes (2 vs. 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.

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