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Albuminuria According to Status of Autoimmunity and Insulin Sensitivity Among Youth With Type 1 and Type 2 Diabetes
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Details:
  • Corporate Authors:
    for the SEARCH for Diabetes in Youth Study Group
  • Pubmed ID:
    23846811
  • Pubmed Central ID:
    PMC3816857
  • Funding:
    00097/PHS HHS/United States
    1U18DP002709/DP/NCCDPHP CDC HHS/United States
    1UL1RR026314-01/RR/NCRR NIH HHS/United States
    200-2010-35171/PHS HHS/United States
    DP-05-06/DP/NCCDPHP CDC HHS/United States
    DP-10-001/DP/NCCDPHP CDC HHS/United States
    K23 DK089017/DK/NIDDK NIH HHS/United States
    M01RR00037/RR/NCRR NIH HHS/United States
    M01RR00069/RR/NCRR NIH HHS/United States
    P30 DK57516/DK/NIDDK NIH HHS/United States
    U01 DP000244/DP/NCCDPHP CDC HHS/United States
    U01 DP000254/DP/NCCDPHP CDC HHS/United States
    U01-DP000246/DP/NCCDPHP CDC HHS/United States
    U01DP000245/DP/NCCDPHP CDC HHS/United States
    U01DP000247/DP/NCCDPHP CDC HHS/United States
    U01DP000248/DP/NCCDPHP CDC HHS/United States
    U01DP000250/DP/NCCDPHP CDC HHS/United States
    U18DP000247-06A1/DP/NCCDPHP CDC HHS/United States
    U18DP002708-01/DP/NCCDPHP CDC HHS/United States
    U18DP002710-01/DP/NCCDPHP CDC HHS/United States
    U18DP002714/DP/NCCDPHP CDC HHS/United States
    U48/CCU419249/PHS HHS/United States
    U48/CCU519239/PHS HHS/United States
    U48/CCU819241-3/PHS HHS/United States
    U48/CCU919219/PHS HHS/United States
    U58/CCU019235-4/PHS HHS/United States
    U58CCU919256/PHS HHS/United States
    UL1 TR000077/TR/NCATS NIH HHS/United States
    UL1RR029882/RR/NCRR NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    OBJECTIVE

    To evaluate whether etiologic diabetes type is associated with the degree of albuminuria in children with diabetes.

    RESEARCH DESIGN AND METHODS

    SEARCH is an observational, longitudinal study of children with diabetes. Youth with newly diagnosed diabetes were classified according to diabetes autoantibody (DAA) status and presence of insulin resistance. We defined insulin resistance as an insulin sensitivity score <25th percentile for the United States general youth population. DAA status was based on positivity for the 65-kD isoform of glutamate decarboxylase and insulinoma-associated protein 2 antigens. The four etiologic diabetes type groups were as follows: DAA+/insulin-sensitive (IS) (n = 1,351); DAA+/insulin-resistant (IR) (n = 438); DAA−/IR (n = 379); and DAA−/IS (n = 233). Urinary albumin:creatinine ratio (UACR) was measured from a random urine specimen. Multivariable regression analyses assessed the independent relationship between the four diabetes type groups and magnitude of UACR.

    RESULTS

    Adjusted UACR means across the four groups were as follows: DAA+/IS = 154 μg/mg; DAA+/IR = 137 μg/mg; DAA−/IR = 257 μg/mg; and DAA−/IS = 131 μg/mg (P < 0.005). Only DAA−/IR was significantly different. We performed post hoc multivariable regression analysis restricted to the two IR groups to explore the contribution of DAA status and insulin sensitivity (continuous) to the difference in UACR between the IR groups. Only insulin sensitivity was significantly associated with UACR (β = −0.54; P < 0.0001).

    CONCLUSIONS

    In youth with diabetes, the DAA−/IR group had a greater UACR than all other groups, possibly because of the greater magnitude of insulin resistance. Further exploration of the relationships between severity of insulin resistance, autoimmunity, and albuminuria in youth with diabetes is warranted.