Risk factors for microalbuminuria in children and adolescents with insulin dependent diabetes mellitus

Abstract

Objective: The aim of this study was to investigate the influence of diabetes duration, puberty, blood pressure, and glycemic control on microalbuminuria (MA) in children with insulin dependent diabetes mellitus (IDDM). Methods: Study population consisted of 44 children and adolescents with IDDM, aged 12.8±3.3 (range= 6-20) years with a disease duration of 5.07±12.6 (range= 1-11) years. Blood pressures were measured using a standard sphygmomanometer. Presence or absence of pubertal signs was determined by physical examination. Hemoglobin A1c value for each patient was obtained by simply averaging 4 hemoglobin A1c measurements within the preceding year. Albumin excretion rate (AER) was measured by an immunoturbidimetric method. MA was defined as an AER between 20 and 200 µg/min in two out of three overnight urine collections. Results: MA was present in 7 patients (15.9 %), ail of whom were pubertal. When patients with and without MA were compared, HbA1c and pubertal status were significantly different between the groups. There was a significant, although somewhat weak, direct correlation between MA and HbA1c (r: 0.30, p= 0.02) during the preceding year, disease duration (r: 0.35, p=0.009), and puberty (r:0.29, p=0.02). The only independent risk factor for MA tested in a logistic regression model was HbA1c (OR = 1.5027, 95% Cl=1.0751-2.1004 p=0.017). Conclusions: Our results indicate that glycemic control, by far, the most important risk factor for MA. Puberty appears to be the second most influential factor. Therefore, those patients with ongoing or completed puberty who have poor metabolic control are the candidates for targeted interventions with the objective of reducing the rate of diabetic nephropathy.