title: Albuminuria according to status of autoimmunity and insulin sensitivity among youth with type 1 and type 2 diabetes.
abstract: OBJECTIVE
  To evaluate whether etiologic diabetes type is associated with the degree of albuminuria in children with diabetes. RESEARCH DESIGN AND METHODS SEARCH: is an observational, longitudinal study of children with diabetes. Youth with newly diagnosed diabetes were classified according to diabetes autoantibody (DAA) status and presence of insulin resistance. We defined insulin resistance as an insulin sensitivity score <25th percentile for the United States general youth population. DAA status was based on positivity for the 65-kD isoform of glutamate decarboxylase and insulinoma-associated protein 2 antigens. The four etiologic diabetes type groups were as follows: DAA(+)/insulin-sensitive (IS) (n = 1,351); DAA(+)/insulin-resistant (IR) (n = 438); DAA(-)/IR (n = 379); and DAA(-)/IS (n = 233). Urinary albumin:creatinine ratio (UACR) was measured from a random urine specimen. Multivariable regression analyses assessed the independent relationship between the four diabetes type groups and magnitude of UACR.
  
  
  RESULTS
  Adjusted UACR means across the four groups were as follows: DAA(+)/IS = 154 μg/mg; DAA(+)/IR = 137 μg/mg; DAA(-)/IR = 257 μg/mg; and DAA(-)/IS = 131 μg/mg (P < 0.005). Only DAA(-)/IR was significantly different. We performed post hoc multivariable regression analysis restricted to the two IR groups to explore the contribution of DAA status and insulin sensitivity (continuous) to the difference in UACR between the IR groups. Only insulin sensitivity was significantly associated with UACR (β = -0.54; P < 0.0001).
  
  
  CONCLUSIONS
  In youth with diabetes, the DAA(-)/IR group had a greater UACR than all other groups, possibly because of the greater magnitude of insulin resistance. Further exploration of the relationships between severity of insulin resistance, autoimmunity, and albuminuria in youth with diabetes is warranted.
authors.affiliation: Corresponding author: Amy K. Mottl, amy_mottl@med.unc.edu.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Mottl
authors.forename: Abigail
authors.initials: A
authors.lastname: Lauer
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Larry M
authors.initials: LM
authors.lastname: Dolan
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Gilliam
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rodriguez
authors.forename: Santica M
authors.initials: SM
authors.lastname: Marcovina
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.forename: Roopa
authors.initials: R
authors.lastname: Kanakatti Shankar
authors.forename: Maryam
authors.initials: M
authors.lastname: Afkarian
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
authors.forename: Michael
authors.initials: M
authors.lastname: Mauer
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mayer-Davis
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000097:blood / Q000453:epidemiology* / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity; D002648:Child; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance / Q000276:immunology*; D008137:Longitudinal Studies; D008297:Male; D054635:Receptor-Like Protein Tyrosine Phosphatases, Class 8 / Q000276:immunology; D014481:United States; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D007328:Insulin; D003404:Creatinine; D054635:Receptor-Like Protein Tyrosine Phosphatases, Class 8; D005968:Glutamate Decarboxylase