Regression of Microalbuminuria (MA) is Common in Youth with Type 1 Diabetes (T1D)

While MA predicts diabetic nephropathy, adults with T1D and MA experience a 50-60% rate of regression to normal (NL). To assess rate of MA regression in pediatric patients, we evaluated 105 youth with T1D, previously classi? ed with intermittent (IMA, n=55) or persistent (PMA, n=50) MA during a 2 year baseline period. Spot urines were analyzed for albumin/creatinine (Alb/Cr). MA, based on Alb/Cr *20 ?g/mg, was de? ned as PMA with *2 elevations or IMA with 1 elevation during baseline and each 2 year followup (F/U) period. Regression to normal (NL) was Alb/Cr <20 ?g/mg. BP and A1c were averaged over the 2 year baseline and during F/U of 7.9±3.4 years (mean±SD, range 0.2-12.2). Youth provided 838 urines (median 7 samples/ patient) after baseline.At baseline, youth (36% male) were 14.6±2.0 years old and had T1D duration of 7.2±2.8 years. A1c was 9.0±1.3% and BP was 110±8/68±5. Baseline IMA vs PMA groups differed in age at T1D diagnosis (8.2±2.8 vs 6.5±3.0, p<.005) and systolic BP (122±8 vs 118±6, p<.05). There were more females in the PMA than IMA group (74 vs 55%, p<.04).Rate of MA regression was similar between baseline IMA and PMA groups (p>.2). In baseline IMA group, 53% regressed to NL, 24% remained IMA, and 24% progressed to PMA. In baseline PMA group, 46% regressed to NL, 38% regressed to IMA, and 16% remained PMA. Only 24 patients (14 with IMA, 10 with PMA at baseline) received ACEI/ARB Rx. Rx was associated with F/U MA (p<.02); 12% of those who regressed to NL had Rx vs 34% of F/U IMA group and 33% of F/U PMA group. Most regression to NL occurred within 2-4 years in the baseline IMA group while regression to NL occurred over 2-10 years in the baseline PMA group. Only F/U A1c and diastolic BP (DBP) differed among F/U NL, IMA, and PMA groups. A1c was 9.4±1.5% in PMA vs 8.7±0.9% and 8.8±1.2% in IMA and NL groups (p).05 for both) and DBP was 75±6 in IMA vs 71±5 in the NL group (p<.008); DBP in the PMA group was intermediate.Youth onset T1D patients had a similar rate of MA regression as adults. A1c and BP remain major contributors to MA in youth with T1D.

AuthorsCR Alleyn, LK Volkening, J Aggarwal, LM Laffel
Therapeutic AreaEndocrinology
Service AreaReal-World Evidence
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