Higher Prevalence of Elevated Albumin Excretion in Youth With Type 2 Than Type 1 Diabetes The SEARCH for Diabetes in Youth Study

University of Washington Seattle, Seattle, Washington, United States
Diabetes care (Impact Factor: 8.42). 11/2007; 30(10):2593-8. DOI: 10.2337/dc07-0450
Source: PubMed


To estimate the prevalence of an elevated albumin-to-creatinine ratio (ACR) (> or = 30 microg/mg) among youth with type 1 or type 2 diabetes and to identify factors associated with elevated ACR and their effect on the relationship between elevated ACR and type of diabetes.
Cross-sectional data were analyzed from 3,259 participants with onset of diabetes at < 20 years of age in the SEARCH for Diabetes in Youth, a multicenter observational study of diabetes in youth. Multiple logistic regression was used to explore determinants of elevated ACR and factors accounting for differences in this prevalence between type 2 and type 1 diabetes.
The prevalence of elevated ACR was 9.2% in type 1 and 22.2% in type 2 diabetes (prevalence ratio 2.4 [95% CI 1.9-3.0]; P < 0.0001). In multiple logistic regression analysis, female sex, A1C and triglyceride values, hypertension, and type of diabetes (type 2 versus type 1) were significantly associated with elevated ACR. Adjustment for variables related to insulin resistance (obesity, hypertension, dyslipidemia, and inflammation) attenuated, but did not completely explain, the association of diabetes type with elevated ACR.
Youth with type 2 diabetes have a higher prevalence of elevated ACR than youth with type 1 diabetes, in an association that apparently does not completely depend on age, duration of diabetes, race/ethnicity, sex, level of glycemic control, or features of insulin resistance.

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    • "Microalbuminuria (≥2.5 mg/mmol) or macroalbuminuria is far more common in T2D when compared to the dominant form of diabetes in children, that is, type 1 diabetes (T1D). In the search for diabetes study, microalbuminuria was present in 22.2% of T2D versus 9.2% in T1D patients [66]. In another study from Canada, 14.2% of T2D subjects had proteinuria. "
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    • "In this study, 26.9% of youth with T2DM had persistent microalbuminuria, and 4.7% had persistent macroalbuminuria, at a mean age of 14.9 years and duration of disease of 1.6 years. This is in keeping with previously reported microalbuminuria rates of 22–42% in children with youth-onset T2DM of <5 years’ duration (7,13,23,24). Macroalbuminuria rates have been reported as high as 17–27% at 5–10 years’ duration (25,26), although most of these other studies did not evaluate persistence of albuminuria and, therefore, may be overestimates. "
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    • "Microalbuminuria is another important risk factor associated with T2D in children and adolescents, which gets worse over the period of time the patient has the disease [142,145-148]. Microalbuminuria is present in 14 - 25% at the moment of diagnosis; its incidence is high during the decade following the diagnosis and is linked to glycemic control. "
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