Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study

@article{citeulike:2562462, abstract = {Objectives To describe independent predictors for the development of microalbuminuria and progression to macroalbuminuria in those with childhood onset type 1 diabetes. Design Prospective observational study with follow-up for 9.8 (SD 3.8) years. Setting Oxford regional prospective study. Participants 527 participants with a diagnosis of type 1 diabetes at mean age 8.8 (SD 4.0) years. Main outcome measures Annual measurement of glycated haemoglobin (HbA1c) and assessment of urinary albumin:creatinine ratio. Results Cumulative prevalence of microalbuminuria was 25.7\% (95\% confidence interval 21.3\% to 30.1\%) after 10 years of diabetes and 50.7\% (40.5\% to 60.9\%) after 19 years of diabetes and 5182 patient years of follow-up. The only modifiable adjusted predictor for microalbuminuria was high HbA1c concentrations (hazard ratio per 1\% rise in HbA1c 1.39, 1.27 to 1.52). Blood pressure and history of smoking were not predictors. Microalbuminuria was persistent in 48\% of patients. Cumulative prevalence of progression from microalbuminuria to macroalbuminuria was 13.9\% (12.9\% to 14.9\%); progression occurred at a mean age of 18.5 (5.8) years. Although the sample size was small, modifiable predictors of macroalbuminuria were higher HbA1c levels and both persistent and intermittent microalbuminuria (hazard ratios 1.42 (1.22 to 1.78), 27.72 (7.99 to 96.12), and 8.76 (2.44 to 31.44), respectively). Conclusion In childhood onset type 1 diabetes, the only modifiable predictors were poor glycaemic control for the development of microalbuminuria and poor control and microalbuminuria (both persistent and intermittent) for progression to macroalbuminuria. Risk for macroalbuminuria is similar to that observed in cohorts with adult onset disease but as it occurs in young adult life early intervention in normotensive adolescents might be needed to improve prognosis. 10.1136/bmj.39478.378241.BE}, author = {Amin, Rakesh and Widmer, Barry and Prevost, Toby A. and Schwarze, Phillip and Cooper, Jason and Edge, Julie and Marcovecchio, Loredana and Neil, Andrew and Dalton, Neil R. and Dunger, David B. }, citeulike-article-id = {2562462}, doi = {10.1136/bmj.39478.378241.BE}, journal = {BMJ}, keywords = {diabetestype1, nephropathy, risk}, month = {March}, pages = {bmj.39478.378241.BE+}, posted-at = {2008-03-19 15:57:41}, priority = {2}, title = {Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study}, url = {http://dx.doi.org/10.1136/bmj.39478.378241.BE}, year = {2008} }

TY - JOUR ID - citeulike:2562462 L3 - citeulike-article-id:2562462 TI - Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study JF - BMJ SP - bmj.39478.378241.BE N2 - Objectives To describe independent predictors for the development of microalbuminuria and progression to macroalbuminuria in those with childhood onset type 1 diabetes. Design Prospective observational study with follow-up for 9.8 (SD 3.8) years. Setting Oxford regional prospective study. Participants 527 participants with a diagnosis of type 1 diabetes at mean age 8.8 (SD 4.0) years. Main outcome measures Annual measurement of glycated haemoglobin (HbA1c) and assessment of urinary albumin:creatinine ratio. Results Cumulative prevalence of microalbuminuria was 25.7% (95% confidence interval 21.3% to 30.1%) after 10 years of diabetes and 50.7% (40.5% to 60.9%) after 19 years of diabetes and 5182 patient years of follow-up. The only modifiable adjusted predictor for microalbuminuria was high HbA1c concentrations (hazard ratio per 1% rise in HbA1c 1.39, 1.27 to 1.52). Blood pressure and history of smoking were not predictors. Microalbuminuria was persistent in 48% of patients. Cumulative prevalence of progression from microalbuminuria to macroalbuminuria was 13.9% (12.9% to 14.9%); progression occurred at a mean age of 18.5 (5.8) years. Although the sample size was small, modifiable predictors of macroalbuminuria were higher HbA1c levels and both persistent and intermittent microalbuminuria (hazard ratios 1.42 (1.22 to 1.78), 27.72 (7.99 to 96.12), and 8.76 (2.44 to 31.44), respectively). Conclusion In childhood onset type 1 diabetes, the only modifiable predictors were poor glycaemic control for the development of microalbuminuria and poor control and microalbuminuria (both persistent and intermittent) for progression to macroalbuminuria. Risk for macroalbuminuria is similar to that observed in cohorts with adult onset disease but as it occurs in young adult life early intervention in normotensive adolescents might be needed to improve prognosis. 10.1136/bmj.39478.378241.BE KW - diabetestype1 KW - nephropathy KW - risk AU - Amin, Rakesh AU - Widmer, Barry AU - Prevost, Toby AU - Schwarze, Phillip AU - Cooper, Jason AU - Edge, Julie AU - Marcovecchio, Loredana AU - Neil, Andrew AU - Dalton, Neil AU - Dunger, David PY - 2008/03/18/ UR - http://dx.doi.org/10.1136/bmj.39478.378241.BE ER -