Summary
The cumulative incidence of microalbuminuria from onset up to 15 years of Type 1 (insulin-dependent) diabetes mellitus and the relative importance of age, duration, blood pressure and metabolic control for subsequent microalbuminuria was studied in 156 children. Urinary albumin excretion and HbA1c were followed at 3-month intervals from onset and systolic and diastolic blood pressure at the same interval from 5 years of diabetes. Persistent microalbuminuria over 20 μg/min developed in 17 children. The cumulative incidence by duration was 24.2% at 15 years of diabetes. Eleven patients developed microalbuminuria after more than 5 years. Among these, first 5-year mean Hb A1c was 8.4 ± 1.3% vs 7.2 ± 1.1% in normoalbuminuric children (p <0.001). The crude relative risk of developing microalbuminuria with a first 5-year mean HbA1c greater than 7.5% was 4.49 (95% confidence interval 1.13–17.84). The age- and duration-adjusted relative risk was 3.51% (0.90–14.42). The year before transition to microalbuminuria neither mean HbA1c nor yearly mean blood pressures, sex or age at onset of diabetes differed from normoalbuminuric children at the same diabetes duration. Age and duration were higher (p = 0.04). The relative importance of early vs later hyperglycaemia, yearly blood pressures, age, age at onset and duration of diabetes for increased albumin excretion rate after more than 5 years, was shown in a multiple regression analysis where the first 5-year mean HbA1c was the only independent predictor (p = 0.02). Six patients had an onset of microalbuminuria before 5 years of diabetes. In this group age, age at onset and yearly mean HbA1c levels did not differ from normoalbuminuric children at the same duration. We conclude that one-fourth of diabetic youth under the age of 21 years develop microalbuminuria within 14 years of diagnosis. Some patients have an early onset of microalbuminuria, not necessarily related to hyperglycaemia, while in later onset cases early hyperglycaemia is strongly related to subsequent microalbuminuria.
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Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet I: 1430–1432
Mogensen CE, Christensen CK (1984) Predicting diabetic nephropathy in insulin-dependent diabetes. N Engl J Med 311: 89–93
Mathiesen ER, Oxenbøll B, Johansen K, Svendsen PA, Deckert T (1984) Incipient nephropathy in type 1 (insulin-dependent) diabetes. Diabetologia 26: 406–410
Messent J, Elliot T, Hill R, Jarrett J, Keen H, Viberti GC (1992) Prognostic significance of microalbuminuria in insulin-dependent diabetes mellitus: a twenty-three year follow-up study. Kidney Int 41: 836–839
Walker J, Close C, Jones S et al. (1991) Glomerular structure in type-1 (insulin-dependent) diabetic patients with normo- and microalbuminuria. Kidney Int 41: 741–748
Wiseman M, Viberti G, Mackintosh D, Jarrett RJ, Keen H (1984) Glycaemia, arterial pressure and micro-albuminuria in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 26: 401–405
Parving H-H, Hommel E, Mathiesen E et al. (1988) Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin-dependent diabetes. BMJ 296: 156–160
Feldt-Rasmussen B, Mathiesen ER, Deckert T (1986) Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes. Lancet II: 1300–1304
Dahlquist G, Rudberg S (1987) The prevalence of microalbuminuria in diabetic children and adolescents and its relation to puberty. Acta Paediatr Scand 76: 795–800
Mathiesen ER, Saurbrey N, Hommel E, Parving H-H (1986) Prevalence of microalbuminuria in children with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 29: 640–643
Berglund J, Lins P-E, Adamson U, Lins L-E (1987) Microalbuminuria in long-term insulin-dependent diabetes mellitus. Acta Med Scand 222: 333–338
Rudberg S, Persson B, Dahlquist G (1992) Increased glomerular filtration rate as a predictor of diabetic nephropathy — An 8-year prospective study. Kidney Int 41: 822–828
Mathiesen ER, Ronn B, Jensen T, Storm B, Deckert T (1990) Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria. Diabetes 39: 245–249
Chase HP, Jackson WE, Hoops SL, Cockerham RS, Archer PG, O'Brien D (1989) Glucose control and the renal and retinal complications of insulin-dependent diabetes. JAMA 261: 1155–1160
D'Antonio J, Ellis D, Doft B et al. (1989) Diabetes complications and glycemic control. The Pittsburgh prospective insulin-dependent diabetes cohort study status report after 5 yr of IDDM. Diabetes Care 12: 694–700
Kofoed-Enevoldsen A, Borch-Johnsen K, Kreiner S, Nerup J, Deckert T (1987) Declining incidence of persistent proteinuria in type-1 (insulin-dependent) diabetic patients in Denmark. Diabetes 36: 205–209
Parving H-H, Hommel E, Damkjaer Nielsen M, Giese J (1988) Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin-dependent diabetes. BMJ 299: 533–536
Salardi S, Cacciari E, Pascucci G et al. (1990) Microalbuminuria in diabetic children and adolescents. Acta Paediatr Scand 79: 437–443
Mortensen HB, Marinelli K, Norgaard K et al. (1990) A nation-wide cross-sectional study of urinary albumin excretion rate, arterial blood pressure and blood glucose control in Danish children with type-1 diabetes mellitus. Diabetic Med 7: 887–897
Mogensen CE, Cachati A, Christensen CK et al. (1985–86) Microalbuminuria: an early marker of renal involvement in diabetes. Uremia Invest 9: 85–95
Jeppson JO, Franzen B, Gaal AB (1980) Simplified determination of hemoglobin A1c in diabetic patients by use of electrofocusing. In: Radola BJ (ed) Electrophoresis: Advanced methods: Biochemical and clinical applications. de Gruyter, Berlin, pp 59–61
Pocock SJ (1991) Clinical trials. A practical approach. Wiley, New York, pp 221–224
Dahl-Jorgensen K, Hanssen K, Kierulf P, Bjoro T, Sandvik L, Aagenaes O (1988) Reduction of urinary albumin excretion after 4 years of continuous subcutaneous insulin infusion in insulin-dependent diabetes mellitus. Acta Endocrinol 117: 19–25
Feldt-Rasmussen B, Jensen T, Lauritzen T, Mathiesen ER, Deckert T (1991) Effect of poor metabolic control on loss of kidney function in type 1 (insulin-dependent) diabetic patients: an update of the Steno studies. Diabetologia 34: 164–170
Krolewski A, Warram J, Chriestlieb R, Busick E, Kahn R (1985) The changing natural history of nephropathy in type 1 diabetes. Am J Med 318: 140–145
Andersen AR, Sandahl Christiansen J, Andersen JK, Kreiner S, Deckert T (1983) Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25: 496–501
Pirart J (1978) Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care 1: 168–188
Hasslacher CM, Stech W, Wahl P, Ritz E (1985) Blood pressure and metabolic control as risk factors for nephropathy in type 1 (insulin-dependent) diabetes. Diabetologia 28: 6–11
Greene DA, Lattimer SA, Sima AAF (1987) Sorbitol, phosphoinositide and the sodium-potassium ATPase in the pathogenesis of diabetic complications. N Engl J Med 316: 599–606
Vlassara H, Brownlee M, Cerami A (1986) Nonenzymatic glycosylation: role in the pathogenesis of diabetic complications. Clin Chem 32 [Suppl 10]: B37-B48
Ramsay RC, Goetz FC, Sutherland DER et al. (1988) Progression of diabetic retinopathy after pancreas transplantation for insulin-dependent diabetes mellitus. N Engl J Med 318: 208–214
Engerman RL, Kern TS (1987) Progression of incipient diabetic retinopathy during good glycemic control. Diabetes 36: 808–812
Lunbaeck K, Christensen NJ, Jensen VA et al. (1970) Diabetes, diabetic angiopathy and growth hormone. Lancet II: 131–133
Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A (1989) Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 32: 219–226
Barzilay J, Warram JH, Bak M, Laffel LMB, Canessa M, Krolewski A (1992) Predisposition to hypertension: risk factor for nephropathy and hypertension in IDDM. Kidney Int 41: 723–730
Jensen JS, Mathiesen ER, Nørgaard K et al. (1990) Increased blood pressure and erythrocyte sodium/lithium countertransport activity are not inherited in diabetic nephropathy. Diabetologia 33: 619–624
Mangili R, Bending JJ, Scott G, Li LK, Gupta A, Viberti GC (1988) Increased sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy. N Engl J Med 318: 146–150
National Heart, Lung and Blood Institute (1977) Report on the Task Force on Blood Pressure Control in Children. Pediatrics 59: [Suppl] 803
Krans HMJ, Porta M, Keen H (1992) Diabetes care and research in Europe: the St Vincent Declaration action programme. WHO, Geneva, pp 29–32
Vigstrup J, Mogensen CE (1985) Proliferative diabetic retinopathy: at risk patients identified by early detection of microalbuminuria. Acta Ophthalmol 63: 530–534
Nørgaard K, Storm B, Graae M, Feldt-Rasmussen B (1989) Elevated albumin excretion and retinal changes in children with type 1 diabetes are related to long-term poor blood glucose control. Diabetic Med 6: 325–328
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Rudberg, S., Ullman, E. & Dahlquist, G. Relationship between early metabolic control and the development of microalbuminuria — a longitudinal study in children with Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 36, 1309–1314 (1993). https://doi.org/10.1007/BF00400811
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DOI: https://doi.org/10.1007/BF00400811