Abstract
Objective: To examine the risk factors for diabetic nephropathy (DN) 10 years after the diagnosis of juvenile-onset type 1 diabetes mellitus (T1DM) in a Taiwanese population.Research Design and Methods: This retrospective, observational, longitudinal cohort study of 224 patients with T1DM for >10 years (mean duration 12.6 years) included participants from the Chang Gung Juvenile Diabetes Eye Study Group. The patients received a T1DM diagnosis before the age of 18 years and were treated at the pediatric endocrine department of Chang Gung Memorial Hospital in Taiwan. The epidemiological and laboratory data such as age, sex, duration of diabetes, self-reported smoking, blood pressure, lipid profiles, urinalysis, and glycated hemoglobin A1c (HbA1c) levels were collected from medical records retrospectively for investigating the relationship between the clinical parameters and the development of DN in T1DM.Results: During follow-up, 44 of the 224 patients (19.6%) developed DN, of whom 61.4% were female. Cox proportional hazards model analysis indicated that the female (HR 3.40, 95% CI 1.66–6.96, p = 0.001), smoking (HR 3.60, 95% CI 1.28–10.10, p = 0.015), HbA1c level (HR 1.27, 95% CI 1.07–1.49, p = 0.005), diastolic blood pressure (HR 1.06, 95% CI 1.03–1.09, p < 0.001) were significantly correlated with DN after adjustment for multiple variables. The tight glucose control with multiple daily injections produced 49 % risk reduction (HR 0.51, 95% CI 0.26–0.98, p = 0.043).Conclusions: The risk of DN in patients with juvenile-onset T1DM 10 years after the T1DM diagnosis was increased with female, smoking, high HbA1c, diastolic blood pressure levels and attenuated by intensive therapy.
Highlights
The prevalence of type 1 diabetes mellitus (T1DM) has increased from 2 to 5% according to large epidemiological studies worldwide
Studies have analyzed diabetic nephropathy (DN) in childhood T1DM, few studies have focused on Asian patients
The patients with DN had higher blood pressure (BP), total cholesterol (TC) levels (180.2 ± 36.6 vs. 167.5 ± 27.5 mg/dL, p = 0.034), TG (4.4 ± 0.5 vs. 4.2 ± 0.3, logtransformed, p = 0.003) and non-HDL-C levels (120.4 ± 34.4 vs. 104.3 ± 27.9 mg/dL, p = 0.007) than those without DN. Both the TC-to-HDL-C and TG-to-HDL-C ratios were higher in the patients with DN (2.87 ± 0.75 vs. 2.61 ± 0.56, p = 0.037 and 1.64 ± 1.41 vs. 1.10 ± 0.82, p = 0.019, respectively)
Summary
The prevalence of type 1 diabetes mellitus (T1DM) has increased from 2 to 5% according to large epidemiological studies worldwide. The only modifiable predictor was glycemic control for the development and progression of microvascular complications in childhood onset type 1 diabetes [4]. The lifetime risk of DN in T1DM patients varies among studies and ethnic groups [5,6,7,8]. Researchers indicated an effect of sex on hyperfiltration in patients with T1DM without complications [9]. Female patients with T1DM and DN had higher renal efferent arteriolar resistance and attenuating protection against the development of renal complications in the hyperfiltration state than male patients. The prevalence DN was higher among male patients than among female patients in the Taiwan National Health Insurance Research Database [10]. None of them had focused on the juvenile-onset population and been lack of long-term follow-up data
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
