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Ramaphane T, Gezmu AM, Tefera E, Gabaitiri L, Nchingane S, Matsheng-Samuel M, Joel D. Prevalence and Factors Associated with Microalbuminuria in Pediatric Patients with Type 1 Diabetes Mellitus at a Large Tertiary-Level Hospital in Botswana. Diabetes Metab Syndr Obes 2021; 14:4415-4422. [PMID: 34754207 PMCID: PMC8572018 DOI: 10.2147/dmso.s322847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Microalbuminuria is considered the earliest sign of diabetic nephropathy among patients with type 1 diabetes mellitus (T1DM). The prevalence of microalbuminuria among African children with T1DM is reported to be high, yet its prevalence and population-specific risk factors in Botswana are not known. AIM This study aimed to determine the prevalence of microalbuminuria among children and young adults with T1DM in Botswana and identify factors associated with microalbuminuria in this population. METHODS A retrospective cross-sectional study was conducted on 127 T1DM patients aged <24 years followed at a pediatric endocrinology clinic in Botswana from 2010 to 2017. Clinical, laboratory, and demographic data were collected using chart review and patient surveys. Descriptive statistics were reported as mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. Prevalence of microalbuminuria was calculated as a simple proportion. Group comparison was done using two-sample independent t-test, X 2-test, or Fisher's exact test and logistic regression to assess for associations. Level of significance was set at p<0.05. RESULTS There were a total of 71 (55.9%) females. The mean age was 18.7 (±5) years and mean duration of T1DM was 6.6 (±4.6) years. Most study participants were of African descent. The prevalence of microalbuminuria was 28.3%. Group comparison revealed gender (p= 0.040), duration of diabetes (p= 0.002), systolic blood pressure (p=0.003), baseline glycated hemoglobin (HbA1c) (p=0.009) and Tanner's stage (p=008) to be significantly associated with microalbuminuria. On binary logistic regression, only gender (p=0.039) and baseline HbA1c (p=0.039) were independently associated with the presences of microalbuminuria. CONCLUSION This study identified a high prevalence of microalbuminuria among children and young adults with T1DM in Botswana and reaffirms the importance of early detection, glycemic control, and regular screening to prevent diabetic nephropathy.
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Affiliation(s)
- Tshireletso Ramaphane
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Alemayehu M Gezmu
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Correspondence: Alemayehu M Gezmu Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Bag UB00713, Gaborone, Botswana Email
| | - Endale Tefera
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Lesego Gabaitiri
- Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | | | | | - Dipesalema Joel
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Al-Agha AE, Alafif MM, Abd-Elhameed IA. Glycemic control, complications, and associated autoimmune diseases in children and adolescents with type 1 diabetes in Jeddah, Saudi Arabia. Saudi Med J 2016; 36:26-31. [PMID: 25630001 PMCID: PMC4362194 DOI: 10.15537/smj.2015.1.9829] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To investigate the relationship between metabolic control, acute and long-term complications, the coexistence of autoimmune diseases, and to assess the different factors that can affect the glycemic control level among children with type 1 diabetes mellitus (T1DM). Methods: This is a cross-sectional study that included 228 T1DM children and adolescents visiting the pediatric diabetes clinic at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia from January 2013 to January 2014. The clinical and laboratory characteristics of the patients were recorded. Metabolic control, complications, and associated autoimmune diseases were evaluated. Results: The mean age of patients was 10.99 years, and the glycated hemoglobin (HbA1c) level was 8.8%. Acute complications included ketoacidosis in 65.4% of patients, and hypoglycemic attacks in 68.9%. Long-term complications were detected in patients including retinopathy (4.4%), microalbuminuria (16.2%), and dyslipidemia (8.3%). Autoimmune thyroiditis was noted in 14%, and celiac disease was found in 19.7% of patients. A significant difference was found in pubertal and pre-pubertal age groups in terms of glycemic control (p=0.01). Conclusion: The level of HbA1c was found to be higher among the pubertal age group. A relationship between autoimmune diseases and gender was determined.
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Affiliation(s)
- Abdulmoein E Al-Agha
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University Hospital, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Fax. +966 (12) 6403841. E-mail.
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Raman S, Dai H, DeLurgio SA, Williams DD, Lind M, Patton SR, Spertus JA, Kosiborod M, Clements MA. High hemoglobin A1c variability is associated with early risk of microalbuminuria in children with T1D. Pediatr Diabetes 2016; 17:398-406. [PMID: 26377593 PMCID: PMC6541408 DOI: 10.1111/pedi.12300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To test the hypothesis that HbA1c variability, as measured by standard deviation (SD), is associated with increased risk for incident microalbuminuria and persistent microalbuminuria in pediatric type 1 diabetes (T1D). METHODS A retrospective analysis using data from electronic health records was performed on 1195 patients from a pediatric diabetes clinic network in the Midwest USA from 1993 to 2009 with ≥1 yr of T1D, ≥4 total HbA1c values, ≥2 HbA1c values/yr, ≥1 urine microalbumin. Microalbuminuria, the main outcome was defined as albumin excretion rate ≥20 mcg/min or 2 of 3 consecutive urine microalbumin/creatinine ≥30 mg/gm. Patients who had persistently high microalbumin or who were treated with an angiotensin-converting-enzyme inhibitor within 1 yr were considered to have persistent microalbuminuria. Sex, race, age, diagnosis age, and duration were covariates. RESULTS Median numbers of per-patient HbA1c and microalbumin results were 14 and 3, respectively. Median intrapersonal mean HbA1c and SD were 8.62% (70.72 mol/mol) and 1.47% (16.07 mmol/mol), respectively. The median interquartile range (IQR) of diagnosis age was 9.4 yr (6.26-12.02) and diabetes duration was 4.97 yr (2.93-7.64). A total of 172 patients (14.4%) developed microalbuminuria; 55 (4.6%) had persistent microalbuminuria. Patients with higher SD of HbA1c had shorter time to microalbuminuria. In time-dependent Cox Proportional Hazard models, updated SD of HbA1c was significantly associated with microalbuminuria [univariate hazard ratio (HR) 1.48 (1.25-1.76); multivariable HR 1.28 (1.04-1.58)], whereas updated mean HbA1c was not [univariate HR 1.08 (0.97-1.22); multivariable HR 1.05 (0.92-1.2)]. Patients with persistent microalbuminuria had similar HRs. CONCLUSIONS HbA1c variability is independently associated with development of microalbuminuria in children with T1D, highlighting the importance of maintaining stable glycemic control in pediatric patients.
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Affiliation(s)
- Sripriya Raman
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,University of Kansas Medical Center, Kansas City, KS, USA
| | - Hongying Dai
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,Department of Research Development and Clinical Investigations, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Stephen A. DeLurgio
- Department of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - David D. Williams
- Department of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Marcus Lind
- Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - John A. Spertus
- Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA,Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Mikhail Kosiborod
- Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA,Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Mark A. Clements
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,University of Kansas Medical Center, Kansas City, KS, USA
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Li L, Jick S, Breitenstein S, Michel A. Prevalence of Diabetes and Diabetic Nephropathy in a Large U.S. Commercially Insured Pediatric Population, 2002-2013. Diabetes Care 2016; 39:278-84. [PMID: 26681728 DOI: 10.2337/dc15-1710] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of diabetes and diabetic nephropathy in a large population of U.S. commercially insured patients aged <18 years from 2002 to 2013. RESEARCH DESIGN AND METHODS Using the U.S. MarketScan Commercial Claims and Encounters Database, we identified 96,171 pediatric patients with diabetes and 3,161 pediatric patients with diabetic nephropathy during 2002-2013. We estimated prevalence of pediatric diabetes overall, by diabetes type, age, and sex, and prevalence of pediatric diabetic nephropathy overall, by age, sex, and diabetes type. RESULTS The annual prevalence of diabetes in the whole pediatric population increased from 1.86 to 2.82 per 1,000 during 2002-2013: 1.48 to 2.32 per 1,000 for type 1 diabetes and 0.38 to 0.67 per 1,000 for type 2 diabetes in 2002-2006 and then 0.56 to 0.49 per 1,000 thereafter. The annual prevalence of diabetic nephropathy in pediatric patients with diabetes increased from 1.16 to 3.44% for all cases and 0.83 to 2.32% for probable cases only in 2002-2013. Prevalence of diabetes and diabetic nephropathy was highest in patients aged 12 to <18 years. While prevalence of type 1 diabetes was higher in male than in female youth, prevalence of type 2 diabetes and diabetic nephropathy was higher in female than in male youth. There was no difference in prevalence of diabetic nephropathy by diabetes type. CONCLUSIONS The prevalence of diabetes and diabetic nephropathy increased in the U.S. MarketScan commercially insured pediatric population from 2002 to 2013. The prevalence of diabetes and diabetic nephropathy markedly increased starting at age 12 years.
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Affiliation(s)
- Lin Li
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA
| | - Susan Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA
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Abstract
In this article, the author reviews the long-term outcomes and their precursors of type 1 diabetes starting in youth. The author also contrasts the changing incidence of these long-term complications as we have moved from the pre-Diabetes Control and Complications Trial (DCCT) to the post-DCCT standard of care and reviews the emerging data related to complications in youths with type 2 diabetes. Finally, the author reviews the recent understanding related to the effects of diabetes on the brain and cognition.
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Affiliation(s)
- Neil H White
- Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Box 8116, St Louis, MO 63110, USA.
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O'Grady MJ, Delaney J, Jones TW, Davis EA. Standardised mortality is increased three-fold in a population-based sample of children and adolescents with type 1 diabetes. Pediatr Diabetes 2013; 14:13-7. [PMID: 22765276 DOI: 10.1111/j.1399-5448.2012.00885.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 05/10/2012] [Indexed: 11/27/2022] Open
Abstract
There are no type 1 diabetes (T1DM) mortality data on Australian children and limited contemporary data on their international counterparts. Fatalities in children and adolescents (1-17 yr) with T1DM were identified from the Western Australia Children's Diabetes Database between 1987-2011. Seventeen thousand four hundred and fifty-three patient-years of diabetes data were analysed and 13 deaths were confirmed (six male). The overall standardised mortality ratio was 3.1 [95% confidence interval (CI), 1.7-5.3] and was highest in the 10-14 yr age group, at 4.6 (95% CI, 1.5-10.8). Median age at death was 16.4 yr (range 5 to 17.8 yr), and median haemoglobin A1c at death was 10.5% (range 6.7 to >14). Cause of death was attributed to diabetes in 10 (77%) cases. Two patients were found 'dead-in-bed'. All diabetes-related deaths in subjects with known T1DM occurred outside the hospital setting.
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Affiliation(s)
- Michael Joseph O'Grady
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, 6008, Australia
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Galler A, Haberland H, Näke A, Hofer S, Holder M, Raile K, Holl RW. Natural course of untreated microalbuminuria in children and adolescents with type 1 diabetes and the importance of diabetes duration and immigrant status: longitudinal analysis from the prospective nationwide German and Austrian diabetes survey DPV. Eur J Endocrinol 2012; 166:493-501. [PMID: 22199141 DOI: 10.1530/eje-11-0695] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify risk factors for the development and progression of untreated persistent microalbuminuria in children and adolescents with type 1 diabetes. DESIGN AND METHODS A total number of 683 children and adolescents with type 1 diabetes recruited from the prospective nationwide German and Austrian diabetes survey (DPV) were included in the analysis. Inclusion criteria were onset of type 1 diabetes under the age of 11 years, diabetes duration of more than 1 year and continuous follow-up over 5 years with at least two documented urine analyses per year. Subjects treated with angiotensin-converting enzyme inhibitors were excluded. Risk factors such as sex, body mass index SDS, diabetes duration, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol, systolic and diastolic blood pressure, and immigrant status were analysed by logistic regression. RESULTS At baseline (age 10.5 ± 0.1 years, diabetes duration 4.6 ± 2.4 years and HbA1c 7.4 ± 1.1%), 75.6% of children had normoalbuminuria, 15.7% had intermittent microalbuminuria, 8.6% had persistent microalbuminuria and 0.1% had macroalbuminuria. After a follow-up of 5 years, 59.4% of adolescents continued to have normoalbuminuria, 18.4% had progression, 15.2% had regression of microalbuminuria, and in 6.9% of the subjects, microalbuminuria remained unchanged. We found significant associations between persistent microalbuminuria at baseline and during each year of follow-up (P < 0.0001). Logistic regression analysis identified diabetes duration and immigrant status as significant factors for microalbuminuria (P = 0.009 and P = 0.009). CONCLUSIONS The survey in a real-world setting shows that diabetes duration and immigrant status are risk factors for the development and progression of untreated microalbuminuria in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Angela Galler
- Charité - Universitätsmedizin Berlin, Paediatric Endocrinology and Diabetology, University Hospital for Children and Adolescents, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Ješić M, Sajić S, Ješić M, Kostić M, Peco-Antić A, Vujnović Z, Necić S. Microalbuminuria in relation to metabolic control and blood pressure in adolescents with type 1 diabetes. Arch Med Sci 2011; 7:1037-41. [PMID: 22328888 PMCID: PMC3264997 DOI: 10.5114/aoms.2011.26617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 07/10/2010] [Accepted: 09/29/2010] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The objective of this study was to assess the frequency of microalbuminuria and the relationship with other risk factors for the development of diabetic nephropathy. MATERIAL AND METHODS Our cross-section study involved a group of 60 adolescence of both sexes, mean age 15.3 ±2.43 years with mean duration of diabetes 7.74 ±3.44 years. Albumin excretion rate was measured on 2-3 samples of the first morning urine in the period below 6 months and persistent microalbuminuria was defined if its increased in two out of three urine specimens. Ambulatory blood pressure was monitored (ABPM, SpaceLabs 90207). RESULTS Microalbuminuria developed in 13.3% of adolescents with mostly completed sexual development, statistically significantly poorer metabolic control (9.79% vs. 8.7%) and higher BMI (23.59 kg/m(2) vs. 20.85 kg/m(2)) than in the patients with normoalbuminuria. The mean night-time systolic blood pressure (SBP) was statistically significantly higher in microalbuminuric patients than in normoalbuminurics. The nocturnal dip was reduced in 41.7% of our patients; 38.5% of nondippers were in normoalbuminuric and 62.5% in microalbuminuric patients. CONCLUSIONS Diabetic adolescents require particular attention in order to minimize the factors such as high HbA(1c), elevated body mass index and night-time SBP in the development of incipient nephropathy.
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Affiliation(s)
- Maja Ješić
- University Childrens Hospital, Belgrade, Serbia
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Kalk W, Raal F, Joffe B. The prevalence and incidence of and risk factors for, micro-albuminuria among urban Africans with type 1 diabetes in South Africa: An inter-ethnic study. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ijdm.2010.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Alleyn CR, Volkening LK, Wolfson J, Rodriguez-Ventura A, Wood JR, Laffel LMB. Occurrence of microalbuminuria in young people with Type 1 diabetes: importance of age and diabetes duration. Diabet Med 2010; 27:532-7. [PMID: 20536948 PMCID: PMC2966306 DOI: 10.1111/j.1464-5491.2010.02983.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine the occurrence of microalbuminuria in young people with Type 1 diabetes mellitus followed prospectively for 2 years and to relate the presence of persistent elevations in urinary albumin excretion (UAE) to age, diabetes duration, puberty and other factors. METHODS During a 2 year period, random urine samples were obtained from 471 patients, aged 8-18 years (mean +/-sd 12.9 +/- 2.3 years) with Type 1 diabetes duration 5.6 +/- 3.0 years, as part of routine clinical care. Urine albumin and creatinine concentrations were measured in 1310 samples (median, 3 samples per patient) and the albumin:creatinine ratio was calculated (in micrograms albumin per milligram creatinine). Height, weight, blood pressure (BP), glycated haemoglobin (HbA(1c)), blood glucose monitoring frequency and Tanner staging were collected from patients' medical records. RESULTS Twenty-three per cent of patients had one or more sample with elevated UAE (> or =20 microg/mg) and 9.3% had persistent elevations (> or =2 samples > or =20 microg/mg). Those with and without persistent microalbuminuria did not differ significantly in age, diabetes duration, z-score for body mass index, pubertal status or BP percentile. Ten per cent of children <13 years old and 9% of children > or =13 years old had persistent microalbuminuria. Persistent microalbuminuria was significantly associated with diabetes duration only in older children (duration 0.5-3 years, 4%; 4-6 years, 8%; > or =7 years, 14%; P = 0.02, trend test). Mean HbA(1c) over the 2 years was 8.7 +/- 1.2%. In a logistic regression model, mean HbA(1c) was the only significant predictor of persistent microalbuminuria (odds ratio 1.3, 95% confidence interval 1.0-1.6, P = 0.05). CONCLUSIONS Microalbuminuria in older children with Type 1 diabetes is likely to be clinically significant. In younger children, it may reflect functional, reversible renal changes. Longitudinal analysis is needed to confirm the probable transient nature of microalbuminuria in young patients with Type 1 diabetes.
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Affiliation(s)
- C R Alleyn
- Pediatric, Adolescent & Young Adult Section, Joslin Diabetes Center, Boston, MA 02215, USA
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Marcovecchio ML, Tossavainen PH, Dunger DB. Status and rationale of renoprotection studies in adolescents with type 1 diabetes. Pediatr Diabetes 2009; 10:347-55. [PMID: 19496962 DOI: 10.1111/j.1399-5448.2009.00510.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Midyett LK, Grunt J, Simon SD. Noninvasive radial artery tonometry augmentation index and urinary albumin/creatinine levels in early adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2009; 22:531-7. [PMID: 19694200 DOI: 10.1515/jpem.2009.22.6.531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with type 1 diabetes mellitus (DM1) are at an even greater risk compared to the general population for the development of cardiovascular disease. Studies have determined that the pathological changes seen in atherosclerosis develop at a very early age. There is a growing consensus within the medical community that early identification of chronic disease may help to reduce morbidity and mortality. The aim of this study was to assess the degree of arterial stiffness by measuring the augmentation index (AIx), using noninvasive radial artery tonometry, in adolescent children with DM1 compared with age-matched controls. In addition, urinary albumin/creatinine ratios were obtained to assess a possible relationship between renal and cardiac dysfunction in patients with DM1. Forty-five adolescents with DM1 and 42 controls between the ages of 12 and 14 years were recruited. Radial artery stiffness and urinary albumin/creatinine ratios of the adolescents with DM1 were not different from controls.
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Affiliation(s)
- L Kurt Midyett
- Section of Endocrinology/Diabetes, Children's Mercy Hospital and Clinics, Kansas City, MO, USA.
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Çizmecioğlu FM, Noyes K, Bath L, Kelnar C. Audit of microalbumin excretion in children with type I diabetes. J Clin Res Pediatr Endocrinol 2009; 1:136-43. [PMID: 21274398 PMCID: PMC3005646 DOI: 10.4008/jcrpe.v1i3.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 02/27/2009] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate prevalence, persistence and clinical correlates of increased microalbumin excretion in random urine samples collected in a paediatric diabetes clinic. METHOD Random urine samples were collected annually in patients >10 years attending the diabetes clinic in the Royal Hospital for Sick Children, Edinburgh. Albumin excretion is expressed as albumin:creatinine ratio (ACR) and classified as normal (10 mg/mmol), or macroalbuminuria (>47 mg/mmol in females, >35 mg/mmol in males). We analyzed retrospectively results on 421 urine samples collected from 217 patients (109 males), of a median age of 12.3 years (94% 10-16 years) over 3 years. For each sample, the corresponding mean HbA1c over the previous year was calculated. RESULTS Prevalence of micro- and macro-albuminuria in individual samples was 1% and 0.5% respectively. ACR was equivocal in 10.1% and 4.7% in samples from females and males respectively (p=0.03). HbA1c showed borderline significant differences across ACR groups (p=0.06). Equivocal ACR excretion was associated with slightly higher mean HbA1c (9.5±1.3%) compared to normal albuminuria (9.0±1.1%, p3.5 mg/mmol. The 14-16 years age group patients were most likely to have ACR >3.5 mg/mmol (p=0.05). CONCLUSIONS Female sex and increasing age, but not HbA1c, were independently associated with increased ACR. A robust mechanism for collection of repeat early morning urine samples from patients with increased ACR in random urine samples, and follow-up of those patients who have persistently high microalbumin excretion are important. It is also important to confirm the usefulness of ACR measurements in random urine samples as a marker of incipent nephropathy.
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Affiliation(s)
- Filiz Mine Çizmecioğlu
- Department of Pediatrics, Endocrinology and Diabetes Unit, University of Kocaeli, Turkey
| | - Kathryn Noyes
- Paediatric Diabetes Department of Diabetes, Royal Hospital for Sick Children, Edinburgh, UK
| | - Louise Bath
- Department of Paediatric Endocrinology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Chris Kelnar
- Professor in Paediatric Endocrinology Department of Diabetes, University of Edinburgh and Royal Hospital for Sick Children, Edinburgh, UK
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Hochhauser CJ, Rapaport R, Shemesh E, Schmeidler J, Chemtob CM. Age at diagnosis, gender, and metabolic control in children with type 1 diabetes. Pediatr Diabetes 2008; 9:303-7. [PMID: 18768035 DOI: 10.1111/j.1399-5448.2008.00395.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine whether age at diagnosis and gender affect early metabolic control in children with type 1 diabetes. DESIGN AND METHODS Data on age at diagnosis, gender, pubertal status, and metabolic control were gathered by a retrospective chart review of children diagnosed between 1992 and 2005. Mean hemoglobin A1c (HbA1c) values were compared at five time points: at diagnosis and at 6, 12, 24, and 36 months after diagnosis. RESULTS At diagnosis, girls aged 6-12 years presented with significantly higher HbA1c levels than girls diagnosed at older or younger ages. Their HbA1c at diagnosis was also significantly higher than that in boys of the same age. There was no gender difference among children diagnosed at ages 0-5 or 13+ yr. At 6 months after diagnosis, only age at diagnosis was associated with metabolic control, with children diagnosed when older presenting with lower HbA1c levels. At 12, 24, and 36 months after diagnosis, there were no significant effects of age at diagnosis or gender on glycemic status. CONCLUSION At initial diagnosis, girls in the 6-12 age group presented with higher HbA1c levels compared with boys and girls of other age groups. Although endocrine changes associated with puberty may partly explain the findings, more investigation to elucidate mechanisms accounting for the interaction of age and gender with glycemic status is needed.
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Affiliation(s)
- Carl J Hochhauser
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA
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Gallego PH, Shephard N, Bulsara MK, van Bockxmeer FM, Powell BL, Beilby JP, Arscott G, Le Page M, Palmer LJ, Davis EA, Jones TW, Choong CSY. Angiotensinogen gene T235 variant: a marker for the development of persistent microalbuminuria in children and adolescents with type 1 diabetes mellitus. J Diabetes Complications 2008; 22:191-8. [PMID: 18413222 DOI: 10.1016/j.jdiacomp.2007.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 02/26/2007] [Accepted: 03/01/2007] [Indexed: 11/30/2022]
Abstract
AIM We examined genetic polymorphisms in the renin-angiotensin system (RAS) coding for angiotensin I-converting enzyme (ACE) insertion/deletion (I/D) for angiotensinogen (AGT) M235T and angiotensin II receptor type 1 (AGTR1) A1166C as predictors for the development of microalbuminuria (MA) in children with type 1 diabetes mellitus (T1DM). METHODS Four hundred fifty-three (215 males, 238 females) T1DM children [median (interquartile range): age, 16.7 years (13.9-18.3); diabetes duration, 6.9 years (3.3-10.8); age at diagnosis, 9.1 years (5.8-11.8)] were followed prospectively from diagnosis until the development of MA (two of three consecutive overnight urine samples with albumin excretion rates of > or =20 and <200 microg/min). Kaplan-Meier survival curves and Cox proportional multivariate model estimated the probability of developing MA and the relative risk for MA among different variables. RESULTS MA developed in 41 (9.1%) subjects. The frequencies of genotypes were as follows: ACE-II 112 (25%), ACE-ID 221 (49%), and ACE-DD 117 (26%) (n=450); AGT-MM 144 (32%), AGT-MT 231 (51%), and AGT-TT 77 (17%) (n=452); AGTR1-AA 211 (47%), AGTR1-AC 204 (45%), and AGTR1-CC 37 (8%) (n=452). The cumulative risk for the development of MA was higher in ACE-DD versus ACE-ID/II groups (log-rank test, P=.05), and a trend was noticed when AGT-TT was compared to AGT-MT/MM groups (log-rank test, P=.08). AGT-TT polymorphism conferred a fourfold increased risk for MA compared to AGT-MM/MT (hazard ratio=3.8; 95% confidence interval=1.43-10.3; P=.008). INTERPRETATION Our findings suggest that RAS gene polymorphism at AGT M235T is a strong predictor for early MA in young T1DM subjects.
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Affiliation(s)
- Patricia H Gallego
- Department of Pediatric Endocrinology and Diabetes, Princess Margaret Hospital, Perth, WA, Australia.
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Bogdanović R. Diabetic nephropathy in children and adolescents. Pediatr Nephrol 2008; 23:507-25. [PMID: 17940807 DOI: 10.1007/s00467-007-0583-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 07/09/2007] [Accepted: 07/12/2007] [Indexed: 12/12/2022]
Abstract
Type 1 diabetes mellitus (T1DM) commonly occurs in childhood or adolescence, although the rising prevalence of type 2 diabetes mellitus (T2DM) in these age groups is now being seen worldwide. Diabetic nephropathy (DN) develops in 15-20% of subjects with T1DM and in similar or higher percentage of T2DM patients, causing increased morbidity and premature mortality. Although overt DN or kidney failure caused by either type of diabetes are very uncommon during childhood or adolescence, diabetic kidney disease in susceptible patients almost certainly begins soon after disease onset and may accelerate during adolescence, leading to microalbuminuria or incipient DN. Therefore, all diabetics warrant ongoing assessment of kidney function and screening for the earliest manifestations of renal injury. Pediatric health care professionals ought to understand about risk factors, strategy for prevention, method for screening, and treatment of early DN. This review considers each form of diabetes separately, including natural history, risk factors for development, screening for early manifestations, and strategy recommended for prevention and treatment of DN in children and adolescents.
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Affiliation(s)
- Radovan Bogdanović
- The Institute of Mother and Child Healthcare of Serbia Dr Vukan Cupic, Belgrade, Serbia.
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Raile K, Galler A, Hofer S, Herbst A, Dunstheimer D, Busch P, Holl RW. Diabetic nephropathy in 27,805 children, adolescents, and adults with type 1 diabetes: effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex. Diabetes Care 2007; 30:2523-8. [PMID: 17630266 DOI: 10.2337/dc07-0282] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Augustenburger Platz 1, 13353 Berlin, Germany.
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Gallego PH, Wiltshire E, Donaghue KC. Identifying children at particular risk of long-term diabetes complications. Pediatr Diabetes 2007; 8 Suppl 6:40-8. [PMID: 17727384 DOI: 10.1111/j.1399-5448.2007.00298.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Formerly a 'taboo' subject, long-term complications are now being increasingly discussed with the family by the health-care team. Identifying potential predictors and establishing early intervention can change the course of these complications in the young patient with diabetes. Although the most recognized risk factor is glycaemic exposure, the development of diabetes complications is likely to result from an interaction between genetic and environmental factors. Other major environmental risk factors are hypertension, smoking, higher body mass index and lipid disorders. This article will concentrate on specific paediatric aspects, including the impact of puberty; endothelial dysfunction and genetic susceptibility. Endothelial function assessed by flow-mediated dilatation is a non-invasive method that has been suitable for use in children and adolescents. In type 1 diabetes mellitus children, endothelium dysfunction has been documented among patients with short diabetes duration and has been correlated to folate status, triglyceride and low-density lipoprotein cholesterol levels. Studies in the paediatric population have also revealed an association of diabetes complications with genetic variants in the renin-angiotensin system, polyol pathway, lipid oxidation and folate metabolism. Currently, achieving the best glycaemic control remains the gold standard for prevention of long-term diabetes complications in the clinical context. However, recent identification of genetic markers and development of research tools that predict long-term complications might have a potential role as instruments in assessing the effectiveness of intervention in the early course of the disease.
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Affiliation(s)
- Patrica H Gallego
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Sydney, Australia
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Huo B, Steffen AT, Swan K, Sikes K, Weinzimer SA, Tamborlane WV. Clinical outcomes and cost-effectiveness of retinopathy screening in youth with type 1 diabetes. Diabetes Care 2007; 30:362-3. [PMID: 17259509 DOI: 10.2337/dc06-1824] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Betty Huo
- Department of Pediatric Endocrinology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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