title: Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study.
abstract: 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.
authors: University Department of Paediatrics, Addenbrooke's Hospital, Cambridge CB2 0QQ.
authors: Rakesh
authors: R
authors: Amin
authors: Barry
authors: B
authors: Widmer
authors: A Toby
authors: AT
authors: Prevost
authors: Phillip
authors: P
authors: Schwarze
authors: Jason
authors: J
authors: Cooper
authors: Julie
authors: J
authors: Edge
authors: Loredana
authors: L
authors: Marcovecchio
authors: Andrew
authors: A
authors: Neil
authors: R Neil
authors: RN
authors: Dalton
authors: David B
authors: DB
authors: Dunger
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents