title: Natural course of untreated microalbuminuria in children and adolescents with type 1 diabetes and the importance of diabetes duration and immigrant status: longitudinal analysis from the prospective nationwide German and Austrian diabetes survey DPV.
abstract: OBJECTIVE
  To identify risk factors for the development and progression of untreated persistent microalbuminuria in children and adolescents with type 1 diabetes.
  
  
  METHODS
  A total number of 683 children and adolescents with type 1 diabetes recruited from the prospective nationwide German and Austrian diabetes survey (DPV) were included in the analysis. Inclusion criteria were onset of type 1 diabetes under the age of 11 years, diabetes duration of more than 1 year and continuous follow-up over 5 years with at least two documented urine analyses per year. Subjects treated with angiotensin-converting enzyme inhibitors were excluded. Risk factors such as sex, body mass index SDS, diabetes duration, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol, systolic and diastolic blood pressure, and immigrant status were analysed by logistic regression.
  
  
  RESULTS
  At baseline (age 10.5 ± 0.1 years, diabetes duration 4.6 ± 2.4 years and HbA1c 7.4 ± 1.1%), 75.6% of children had normoalbuminuria, 15.7% had intermittent microalbuminuria, 8.6% had persistent microalbuminuria and 0.1% had macroalbuminuria. After a follow-up of 5 years, 59.4% of adolescents continued to have normoalbuminuria, 18.4% had progression, 15.2% had regression of microalbuminuria, and in 6.9% of the subjects, microalbuminuria remained unchanged. We found significant associations between persistent microalbuminuria at baseline and during each year of follow-up (P < 0.0001). Logistic regression analysis identified diabetes duration and immigrant status as significant factors for microalbuminuria (P = 0.009 and P = 0.009).
  
  
  CONCLUSIONS
  The survey in a real-world setting shows that diabetes duration and immigrant status are risk factors for the development and progression of untreated microalbuminuria in children and adolescents with type 1 diabetes.
authors.affiliation: Charité - Universitätsmedizin Berlin, Paediatric Endocrinology and Diabetology, University Hospital for Children and Adolescents, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. angela.galler@charite.de
authors.forename: Angela
authors.initials: A
authors.lastname: Galler
authors.forename: Holger
authors.initials: H
authors.lastname: Haberland
authors.forename: Andrea
authors.initials: A
authors.lastname: Näke
authors.forename: Sabine
authors.initials: S
authors.lastname: Hofer
authors.forename: Martin
authors.initials: M
authors.lastname: Holder
authors.forename: Klemens
authors.initials: K
authors.lastname: Raile
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000419:Albuminuria / Q000208:ethnology* / Q000473:pathology*; D001317:Austria / Q000208:ethnology; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000208:ethnology* / Q000473:pathology*; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000208:ethnology; D006306:Health Surveys / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors