Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes
- 1 October 2007
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 30 (10), 2523-2528
- https://doi.org/10.2337/dc07-0282
Abstract
OBJECTIVE—To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease. RESEARCH DESIGN AND METHODS—A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8–14.3]), age at last visit 16.34 years (12.5–22.2), and follow-up time 2.5 years (0.43–5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and association with risk factors by logistic regression. RESULTS—Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78, and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% (95% CI 22.3–28.3) had microalbuminuria and 9.4% (8.3–11.4) had macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P < 0.0001), A1C (1.13, P < 0.0001), LDL cholesterol (1.003, P < 0.0074), and blood pressure (1.008, P < 0.0074), while childhood diabetes onset (1.011, P < 0.0001) was protective. Male sex was associated with the development of macroalbuminuria. CONCLUSIONS—Diabetes duration, A1C, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes.Keywords
This publication has 32 references indexed in Scilit:
- Prevalence and risk factors for microalbuminuria in a population-based sample of children and adolescents with T1DM in Western AustraliaPediatric Diabetes, 2006
- Spectrum and Prevalence of Atherogenic Risk Factors in 27,358 Children, Adolescents, and Young Adults With Type 1 DiabetesDiabetes Care, 2006
- Lipoproteins in the DCCT/EDIC cohort: Associations with diabetic nephropathyKidney International, 2003
- Impact of Metabolic Control and Serum Lipids on the Concentration of Advanced Glycation End Products in the Serum of Children and Adolescents With Type 1 Diabetes, as Determined by Fluorescence Spectroscopy and Nε-(Carboxymethyl)Lysine ELISADiabetes Care, 2003
- Do All Prepubertal Years of Diabetes Duration Contribute Equally to Diabetes Complications?Diabetes Care, 2003
- Treatment of hypertension and microalbuminuria in children and adolescents with type 1 diabetes mellitusPediatric Diabetes, 2002
- Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control.Diabetes Care, 1999
- Microalbuminuria prevalence varies with age, sex, and puberty in children with type 1 diabetes followed from diagnosis in a longitudinal study. Oxford Regional Prospective Study Group.Diabetes Care, 1999
- Computer Programs and DatasheetsHormone Research in Paediatrics, 1998
- Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications TrialThe Journal of Pediatrics, 1994