The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes

Details

• Alternative Title:
  J Diabetes Complications
• Personal Author:
  Kahkoska, Anna R. ; Isom, Scott ; Divers, Jasmin ; Mayer-Davis, Elizabeth J. ; Dolan, Lawrence ; Shah, Amy S. ; Afkarian, Maryam ; Pettitt, David J. ; Lawrence, Jean M. ; Marcovina, Santica ; Saydah, Sharon H. ; Dabelea, Dana ; Maahs, David M. ; Mottl, Amy K.
• Corporate Authors:
  for the SEARCH for Diabetes in Youth Study Group
• Description:
  AIMS:
  
  To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression. The research hypothesis was that youth with type 2 diabetes would be more likely to show progression of albuminuria.
  
  METHODS:
  
  Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N=1316) and type 2 diabetes (N=143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7 years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ≥30μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30μg/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression).
  
  RESULTS:
  
  Albuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR)=1.3, 95% CI 1.1–1.6) and lack of private health insurance (aOR=2.7, 95%CI 1.1–6.5) in type 1 diabetes; and African American race (OR=4.6, 95% CI 1.2–14.2), lower estimated insulin sensitivity score (aOR=2.1, 95% CI 1.4–3.3), baseline UACR (aOR=3.2, 95% CI 1.7–5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR=1.3, 95% CI 1.0, 1.5) in type 2 diabetes.
  
  CONCLUSIONS:
  
  In the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Interventions are needed even at very early stages of disease to reduce the long-term consequences of diabetic kidney disease in youth-onset diabetes.
  
  
• Subjects:
  Adolescent Adult Age Of Onset Albuminuria Article Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetic Nephropathies Disease Progression Epidemiology Female Follow-Up Studies Humans Longitudinal Studies Male Nephropathy Pediatric Type 1 Diabetes Pediatric Type 2 Diabetes Prevalence Registries Risk Factors United States Young Adult

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• Source:
  J Diabetes Complications. 32(12):1160-1168
• Pubmed ID:
  30316542
• Pubmed Central ID:
  PMC6289668
• Document Type:
  Journal Article
• Funding:
  P30 DK057516/DK/NIDDK NIH HHS/United States ; UC4 DK108173/DK/NIDDK NIH HHS/United States ; U01 DP000247/DP/NCCDPHP CDC HHS/United States ; T32 DK007750/DK/NIDDK NIH HHS/United States ; U18 DP002710/DP/NCCDPHP CDC HHS/United States ; UL1 TR000154/TR/NCATS NIH HHS/United States ; U18 DP002714/DP/NCCDPHP CDC HHS/United States ; U01 DP000248/DP/NCCDPHP CDC HHS/United States ; U01 DP000244/DP/NCCDPHP CDC HHS/United States ; UL1 TR000062/TR/NCATS NIH HHS/United States ; K23 DK093804/DK/NIDDK NIH HHS/United States ; U18 DP002709/DP/NCCDPHP CDC HHS/United States ; UL1 TR002319/TR/NCATS NIH HHS/United States ; UL1 TR000077/TR/NCATS NIH HHS/United States ; UL1 TR000423/TR/NCATS NIH HHS/United States ; U01 DP000250/DP/NCCDPHP CDC HHS/United States ; U01 DP000246/DP/NCCDPHP CDC HHS/United States ; U01 DP000254/DP/NCCDPHP CDC HHS/United States ; U18 DP002708/DP/NCCDPHP CDC HHS/United States
• Volume:
  32
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ad1d159c1e1f9c4f87ad30f1584c1374a3a87437426cc248eb2cf2697292924e
• Download URL:
  https://stacks.cdc.gov/view/cdc/61313/cdc_61313_DS1.pdf
• File Type:
  [PDF - 405.13 KB ]