Background: Microalbuminuria is usually the earliest sign of diabetic nephropathy. However, it does not always progress to macroalbuminuria,and may regress to normoalbuminuria. Mean HbA1c and HbA1c variability was known to be independent risk factors for microalbuminuria in children with type 1 diabetes.
Objective and hypotheses: We hypothesised that both mean and variability of HbA1c could affect the progression to macroalbuminuria in children with type 1 diabetes.
Method: Thirty eight patients with type 1 diabetes who developed microalbuminuria were included in the study. Patients who had progressed to macroalbuminuria were categorized as progression group and Other patients were grouped as non-progression group. Data were collected 2 years prior to the onset of microalbuminuria in all patients to the onset of macroalbuminuria in progression group and to the last follow up date in non-progression group.
Results: Eleven patients (29%) had progressed to macroalbuminuria and 27 patients had not progressed. Follow up duration were 6.4±5.2 years and 6.2±3.8 years, respectively. Mean HbA1c before the microalbuminuria (P=0.004), mean (P<0.001) and variability (P=0.003) of HbA1c after microalbuminuria, total cholesterol (P=0.009) at diagnosis of microalbuinuria were related factors on the progression to macroalbuminuria in univariate analysis. In multivariate analysis, mean HbA1c after microalbuminuria was the only significant risk factor for the progression to macroalbuminuria and hazard ratio for progression was 17.9 (95 percent confidence interval, 2.12 to 151).
Conclusion: Poor glycaemic control was the unsurpassed risk factor for the development of diabetic nephropathy. In our study, HbA1c variability after onset of microalbuminuria was not the major contributor for the progression to macroalbuminuria after adjusted by mean HbA1c.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology