Microalbuminuria and glycated hemoglobin in children with type 1 diabetes mellitus

Abstract

Diabetic nephropathy (DNP) is a microvascular complication that occurs in 20–40% of patients with type 1 diabetes (T1D). The main modifiable DNP initiation and progression factors in susceptible individuals may be sustained hyperglycemia and hypertension. The aim of the present work was to study glycemic control in children with T1D and the risk of microalbuminuria (MA) expressed as the urinary albumin/creatinine ratio (ACR).
Subjects and methods: Forty children with T1D attending the diabetes clinic at the Alexandria University Children’s Hospital with a duration of diabetes of 3 years or more were included in the study and twenty apparently normal children were taken as controls. Clinical examination and blood pressure measurements were performed for all cases. Urine samples were collected within a 3–6 month period. The ACR in 2 of 3 specimens should be >30 mg/g before considering a patient to have microalbuminuria. HbA1c was measured and the mean of the last 4 readings was calculated.
Results: 77.5% of patients had ACR >30 mg/g in two different samples. 88.8% of patients with poor glycemic control had MA compared to 53.8% with accepted glycemic control. The difference was more statistically significant among the adolescent age group (P = 0.001). MA was found in 77.2% of children with duration of T1D less than 5 years but the highest proportion was found when the disease duration was more than 10 years. There was no significant difference in systolic and diastolic blood pressure among diabetic children with and without MA (P = 0.556 and 0.781).

Conclusion: Microalbuminuria in children with T1 DM is not limited to those with disease
duration of 5 years or more and it may occur earlier. MA is significantly associated with poor glycemic control especially in adolescents. Other factors that may contribute to MA are not yet fully understood, further research is needed to clarify these factors.