Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 5-6, Pages: 315-319
https://doi.org/10.2298/SARH1306315J
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The effect of metabolic and hormonal parameters on microalbuminuria in adolescents with type 1 diabetes mellitus
Ješić Maja (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Ješić Miloš (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Sajić Silvija (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Bogićević Dragana (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Buljugić Svetlana (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Maglajlić Svjetlana (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Introduction. The prevalence of microalbuminuria (MA), the most important
early marker of incipient nephropathy in patients with type 1 diabetes
mellitus (T1DM), increases during puberty, the period of exaggerated
physiological insulin resistance. Objective. To assess the prevalence of MA
and the relationship between MA and metabolic risk factors and pubertal
hormones in adolescents with T1DM. Methods. In a cross-section study
involving a group of 100 adolescents of both sexes of mean age 14.90±2.18
years and with mean duration of T1DM 5.99±3.64 years, we assessed the
presence of MA. In all patients, we determined albumin-to-creatinine ratio
(ACR) in two or three morning first-void urine samples in the period up to 6
months. Persistent MA was confirmed in the patients with the finding of ACR
rating 2.5-25 mg/mmol in males and 3.5-25 mg/mmol in females in two out of
three first morning urine samples. Results. MA developed in 16 (16.0%)
patients. Predictors of MA determined by using multiple logistic regression
were high HbA1c (OR 4.6; 95% CI 2.1-10.0), higher night-time SBP (OR 1.9; 95%
CI 0.8-1.3) and higher insulin dose (OR 62.6; 95% CI 2.3-1678.5). Markers of
insulin resistance such as higher body mass index (BMI) which was
statistically significantly related to MA (ρ= 0.241, p<0.05) and higher
dehydroepiandrosterone sulfate (DHEA-S) which was significantly higher in
patients with MA (7.82 µmol/L vs. 5.02 µmol/L, p<0.01), were also identified
as predictors but did not remain significant by multivariate analysis,
possibly because of a small sample of subjects with persistent MA.
Conclusion. In addition to poor glycemic control and higher night-time
systolic blood pressure, markers of insulin resistance (higher insulin dose,
higher BMI and higher DHEA-S) contribute to the increased risk of MA.
Keywords: microalbuminuria, type 1 diabetes mellitus, adolescents