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.

Download full-text


Available from: Beatriz L Rodriguez
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents.
    Full-text · Article · Oct 2013 · International Journal of Pediatrics
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate renal outcomes and survival in youth with type 2 diabetes (T2DM) versus type 1 diabetes (T1DM) versus nondiabetic control subjects. In total, 342 prevalent youth (aged 1-18 years) with T2DM, 1,011 youth with T1DM, and 1,710 control subjects identified from 1986 to 2007 were anonymously linked to health care records housed at the Manitoba Centre for Health Policy to assess long-term outcomes using ICD codes. Youth with T2DM were found to have a fourfold increased risk of renal failure versus youth with T1DM. Risk factors associated with renal failure were renin angiotensin aldosterone system inhibitor use and albuminuria in adolescence. Compared with control subjects (age, sex, and postal code matched), youth with T2DM had a 23-fold increased risk of renal failure and a 39-fold increased risk of dialysis. Kaplan-Meier survival at 10 years was 91.4% in the type 2 diabetic group versus 99.5% in the type 1 diabetic group (P < 0.0001). Renal survival was 100% at 10 years in both groups. It decreased to 92.0% at 15 years and 55.0% at 20 years in the type 2 diabetic group but remained stable in the type 1 diabetic group (P < 0.0001). Youth with T2DM are at high risk of adverse renal outcomes and death. Albuminuria and angiotensin aldosterone system inhibitor use, which may be a marker of severity of disease, are associated with poor outcomes in early adulthood.
    Full-text · Article · Mar 2012 · Diabetes care
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life. The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations. The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success. The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.
    Full-text · Article · Aug 2010 · Diabetology and Metabolic Syndrome
Show more