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

for the SEARCH for Diabetes in Youth Study Group

    Research output: Contribution to journalArticle

    Abstract

    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. 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 ≥30 μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30 μg/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. Early interventions may help reduce long-term kidney complications.

    Original languageEnglish (US)
    JournalJournal of Diabetes and its Complications
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Albuminuria
    Type 1 Diabetes Mellitus
    Type 2 Diabetes Mellitus
    Young Adult
    Albumins
    Urine
    Creatinine
    Glomerular Filtration Rate
    Insulin Resistance
    Kidney
    Health Insurance
    African Americans
    Observational Studies
    Longitudinal Studies

    Keywords

    • Albuminuria
    • Epidemiology
    • Nephropathy
    • Pediatric type 1 diabetes
    • Pediatric type 2 diabetes

    ASJC Scopus subject areas

    • Internal Medicine
    • Endocrinology, Diabetes and Metabolism
    • Endocrinology

    Cite this

    The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes. / for the SEARCH for Diabetes in Youth Study Group.

    In: Journal of Diabetes and its Complications, 01.01.2018.

    Research output: Contribution to journalArticle

    @article{0bda1fc8f3044c869f10ee8ac4cf2578,
    title = "The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes",
    abstract = "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. 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 ≥30 μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30 μg/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. Early interventions may help reduce long-term kidney complications.",
    keywords = "Albuminuria, Epidemiology, Nephropathy, Pediatric type 1 diabetes, Pediatric type 2 diabetes",
    author = "{for the SEARCH for Diabetes in Youth Study Group} and Kahkoska, {Anna R.} and Scott Isom and Jasmin Divers and Mayer-Davis, {Elizabeth J.} and Lawrence Dolan and Shah, {Amy S.} and Maryam Afkarian and Pettitt, {David J.} and Lawrence, {Jean M.} and Santica Marcovina and Saydah, {Sharon H.} and Dana Dabelea and Maahs, {David M.} and Mottl, {Amy K.}",
    year = "2018",
    month = "1",
    day = "1",
    doi = "10.1016/j.jdiacomp.2018.09.018",
    language = "English (US)",
    journal = "Journal of Diabetes and its Complications",
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    T1 - The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes

    AU - for the SEARCH for Diabetes in Youth Study Group

    AU - Kahkoska, Anna R.

    AU - Isom, Scott

    AU - Divers, Jasmin

    AU - Mayer-Davis, Elizabeth J.

    AU - Dolan, Lawrence

    AU - Shah, Amy S.

    AU - Afkarian, Maryam

    AU - Pettitt, David J.

    AU - Lawrence, Jean M.

    AU - Marcovina, Santica

    AU - Saydah, Sharon H.

    AU - Dabelea, Dana

    AU - Maahs, David M.

    AU - Mottl, Amy K.

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - 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. 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 ≥30 μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30 μg/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. Early interventions may help reduce long-term kidney complications.

    AB - 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. 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 ≥30 μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30 μg/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. Early interventions may help reduce long-term kidney complications.

    KW - Albuminuria

    KW - Epidemiology

    KW - Nephropathy

    KW - Pediatric type 1 diabetes

    KW - Pediatric type 2 diabetes

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    DO - 10.1016/j.jdiacomp.2018.09.018

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