title: The effect of metabolic and hormonal parameters on microalbuminuria in adolescents with type 1 diabetes mellitus.
abstract: BACKGROUND
  The prevalence of microalbuminuria (MA), the most important early marker of incipient nephropathy in patients with type 1 diabetes mellitus (T1DM), increases during puberty, the period of exaggerated physiological insulin resistance.
  
  
  OBJECTIVE
  To assess the prevalence of MA and the relationship between MA and metabolic risk factors and pubertal hormones in adolescents with T1DM.
  
  
  METHODS
  In a cross-section study involving a group of 100 adolescents of both sexes of mean age 14.90+/-2.18 years and with mean duration ofT1DM 5.99+/-73.64 years, we assessed the presence of MA. In all patients, we determined albumin-to-creatinine ratio (ACR) in two or three morning first-void urine samples in the period up to 6 months. Persistent MA was confirmed in the patients with the finding of ACR rating 2.5-25 mg/mmol in males and 3.5-25 mg/mmol in females in two out of three first morning urine samples.
  
  
  RESULTS
  MA developed in 16 (16.0%) patients. Predictors of MA determined by using multiple logistic regression were high HbA1c (OR 4.6; 95% CI 2.1-10.0), higher night-time SBP (OR 1.9; 95% CI 0.8-1.3) and higher insulin dose (OR 62.6; 95% CI 2.3-1678.5). Markers of insulin resistance such as higher body mass index (BMI) which was statistically significantly related to MA (p= 0.241, p<0.05) and higher dehydroepiandrosterone sulfate (DHEA-S) which was significantly higher in patients with MA (7.82 micromol/L vs. 5.02 micromol/L, p<0.01), were also identified as predictors but did not remain significant by multivariate analysis, possibly because of a small sample of subjects with persistent MA.
  
  
  CONCLUSIONS
  In addition to poor glycemic control and higher night-time systolic blood pressure, markers of insulin resistance (higher insulin dose, higher BMI and higher DHEA-S) contribute to the increased risk of MA.
authors.affiliation: University of Belgrade, Serbia. maja.jesic@udk.bg.ac.rs
authors.forename: Maja
authors.initials: M
authors.lastname: Jesić
authors.forename: Milos
authors.initials: M
authors.lastname: Jesić
authors.forename: Silvija
authors.initials: S
authors.lastname: Sajić
authors.forename: Dragana
authors.initials: D
authors.lastname: Bogićević
authors.forename: Svetlana
authors.initials: S
authors.lastname: Buljugić
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Maglajlić
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001795:Blood Pressure Determination / Q000379:methods; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D015995:Prevalence; D011627:Puberty / Q000378:metabolism; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine; D019314:Dehydroepiandrosterone Sulfate; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin