Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study.
OBJECTIVE
To describe independent predictors for the development of microalbuminuria and progression to macroalbuminuria in those with childhood onset type 1 diabetes.


METHODS
Prospective observational study with follow-up for 9.8 (SD 3.8) years.


METHODS
Oxford regional prospective study.


METHODS
527 participants with a diagnosis of type 1 diabetes at mean age 8.8 (SD 4.0) years.


METHODS
Annual measurement of glycated haemoglobin (HbA1c) and assessment of urinary albumin:creatinine ratio.


RESULTS
Cumulative prevalence of microalbuminuria was 25.7% (95% confidence interval 21.3% to 30.1%) after 10 years of diabetes and 50.7% (40.5% to 60.9%) after 19 years of diabetes and 5182 patient years of follow-up. The only modifiable adjusted predictor for microalbuminuria was high HbA1c concentrations (hazard ratio per 1% rise in HbA1c 1.39, 1.27 to 1.52). Blood pressure and history of smoking were not predictors. Microalbuminuria was persistent in 48% of patients. Cumulative prevalence of progression from microalbuminuria to macroalbuminuria was 13.9% (12.9% to 14.9%); progression occurred at a mean age of 18.5 (5.8) years. Although the sample size was small, modifiable predictors of macroalbuminuria were higher HbA(1c) levels and both persistent and intermittent microalbuminuria (hazard ratios 1.42 (1.22 to 1.78), 27.72 (7.99 to 96.12), and 8.76 (2.44 to 31.44), respectively).


CONCLUSIONS
In childhood onset type 1 diabetes, the only modifiable predictors were poor glycaemic control for the development of microalbuminuria and poor control and microalbuminuria (both persistent and intermittent) for progression to macroalbuminuria. Risk for macroalbuminuria is similar to that observed in cohorts with adult onset disease but as it occurs in young adult life early intervention in normotensive adolescents might be needed to improve prognosis.
Amin
Rakesh
R
University Department of Paediatrics, Addenbrooke's Hospital, Cambridge CB2 0QQ.
Widmer
Barry
B
Prevost
A Toby
AT
Schwarze
Phillip
P
Cooper
Jason
J
Edge
Julie
J
Marcovecchio
Loredana
L
Neil
Andrew
A
Dalton
R Neil
RN
Dunger
David B
DB
D000419:Albuminuria / Q000188:drug therapy / Q000209:etiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
D000959:Antihypertensive Agents