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Study on factors associated with urinary albumin-to-creatinine ratio among adults with type 1 diabetes mellitus

  • 1.

    The First Affiliated Hospital of USTC(Anhui Provincial Hospital),Hefei 230001, China

  • 2.

    The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China

Cite this:
https://doi.org/10.3969/j.issn.0253-2778.2020.04.011
  • Received Date: 02 December 2019
  • Accepted Date: 20 April 2020
  • Rev Recd Date: 20 April 2020
  • Publish Date: 30 April 2020
    Abstract

  • Abstract

    Objective Diabetic kidney disease (DKD) is closely related to end-stage renal failure and increased risk of cardiovascular disease in type 1 diabetes mellitus (T1DM). To investigate factors associated with urinary albumin-to-creatinine ratio (UACR) and establish the prediction model for elevation of UACR among adults with T1DM. Methods Eligible adults with T1DM from Guangdong Type 1 Diabetes Translational Study who were enrolled between January, 2016 and December, 2017. Basic characteristics and clinical information were collected. All patients were divided into two groups: normal UACR group (UACR < 30 mg/g) and elevated UACR group (UACR ≥ 30 mg/g) according to their UACR level. To screen factors that were potentially associated with UACR, comparison of clinical variables between the two groups were performed. Logistic regression analysis and Nomogram model were used to explore major factors associated with UACR and to predict the probability of UACR elevation. Results A total of 495 patients were enrolled, with a mean age of (34.44±11.65) years and diabetes duration of (7.83±6.22) years. Among them, 296 patients (59.8%) were women. 385 patients (77.8%) were assigned to the normal UACR group and 110 patients (22.2%) to the elevated UACR group. Findings from the comparisons between the two groups demonstrated that diabetes duration, systolic blood pressure(SBP), diastolic blood pressure(DBP), resting heart rate, glycosylated hemoglobin A1c(HbA1c), estimated glucose disposal rate (lneGDR), hypertension were associated with UACR. The results of logistic regression showed that lneGDR [OR=0.33 (95%CI，0.17～0.60), P＜0.05] was a protective factor from UACR elevation, while resting heart rate [OR=1.03 (95% CI, 1.00～1.05), P＜0.05] and presence of hypertension [OR=2.17 (95% CI, 1.29～3.63), P＜0.05] were risk factors. The Nomogram model suggested that a higher probability of UACR elevation was associated with lower lneGDR (i.e., greater insulin resistance), higher resting heart rate, longer diabetes duration and the presence of hypertension. Conclusion Many factors were associated with UACR among adult T1DM patients in China. It is possible to reduce the incidence of UACR by improving insulin resistance, controlling resting heart rate and blood pressure, so as to provide ideas for the prevention and control of DKD among adults with type 1 diabetes mellitus.

    Abstract

    Objective Diabetic kidney disease (DKD) is closely related to end-stage renal failure and increased risk of cardiovascular disease in type 1 diabetes mellitus (T1DM). To investigate factors associated with urinary albumin-to-creatinine ratio (UACR) and establish the prediction model for elevation of UACR among adults with T1DM. Methods Eligible adults with T1DM from Guangdong Type 1 Diabetes Translational Study who were enrolled between January, 2016 and December, 2017. Basic characteristics and clinical information were collected. All patients were divided into two groups: normal UACR group (UACR < 30 mg/g) and elevated UACR group (UACR ≥ 30 mg/g) according to their UACR level. To screen factors that were potentially associated with UACR, comparison of clinical variables between the two groups were performed. Logistic regression analysis and Nomogram model were used to explore major factors associated with UACR and to predict the probability of UACR elevation. Results A total of 495 patients were enrolled, with a mean age of (34.44±11.65) years and diabetes duration of (7.83±6.22) years. Among them, 296 patients (59.8%) were women. 385 patients (77.8%) were assigned to the normal UACR group and 110 patients (22.2%) to the elevated UACR group. Findings from the comparisons between the two groups demonstrated that diabetes duration, systolic blood pressure(SBP), diastolic blood pressure(DBP), resting heart rate, glycosylated hemoglobin A1c(HbA1c), estimated glucose disposal rate (lneGDR), hypertension were associated with UACR. The results of logistic regression showed that lneGDR [OR=0.33 (95%CI，0.17～0.60), P＜0.05] was a protective factor from UACR elevation, while resting heart rate [OR=1.03 (95% CI, 1.00～1.05), P＜0.05] and presence of hypertension [OR=2.17 (95% CI, 1.29～3.63), P＜0.05] were risk factors. The Nomogram model suggested that a higher probability of UACR elevation was associated with lower lneGDR (i.e., greater insulin resistance), higher resting heart rate, longer diabetes duration and the presence of hypertension. Conclusion Many factors were associated with UACR among adult T1DM patients in China. It is possible to reduce the incidence of UACR by improving insulin resistance, controlling resting heart rate and blood pressure, so as to provide ideas for the prevention and control of DKD among adults with type 1 diabetes mellitus.
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    • References(23)
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    WADN J, FORSBLOM C, Thorn L M, et al. Adult stature and diabetes complications in patients with type 1 diabetes: The FinnDiane study and the diabetes control and complications trial[J]. Diabetes, 2009, 58(8): 1914-1920.
    [2]
    TONELLI M, MUNTNER P, LLOYD A, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: A population-level cohort study[J]. Lancet, 2012, 380(9844): 807-814.
    [3]
    Diabetes Prevention Program Research Group. Changes in albumin excretion in the Diabetes Prevention Program[J]. Diabetes Care, 2009, 32(4): 720-725.
    [4]
    National Kidney Foundation.KDOQI clinical practice guideline for diabetes and CKD: 2012 update[J]. American Journal of Kidney Diseases, 2012, 60(5): 850-886.
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    THORN L M, FORSBLOM C, WADN J, et al. Metabolic syndrome as a risk factor for cardiovascular disease, mortality, and progression of diabetic nephropathy in type 1 diabetes[J]. Diabetes Care, 2009, 32(5): 950-952.
    [6]
    SZADKOWSKA A,PIETRZAK I, MIANOWSKA B, et al. Insulin sensitivity in type 1 diabetic children and adolescents[J]. Diabetic Medicine, 2008, 25(3): 282-288.
    [7]
    LOVSHIN J A, KRTIC＇ M, PETTER B, et al. Hyperfiltration, urinary albumin excretion, and ambulatory blood pressure in adolescents with type 1 diabetes mellitus[J]. American Journal of Physiology-Renal Physiology, 2018, 314(4): F667-F674.
    [8]
    COSTACOU T, CRANDELL J, KAHKOSKA A R, et al. Dietary patterns over time and microalbuminuria in youth and young adults with type 1 diabetes: The SEARCH Nutrition Ancillary Study[J]. Diabetes Care, 2018, 41(8): 1615-1622.
    [9]
    MARCOVECCHIO M L, WOODSIDE J, JONES T, et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): Urinary screening and baseline biochemical and cardiovascular assessments[J]. Diabetes Care, 2014, 37: 805-813.
    [10]
    DEMIREL F, TEPE D, KARA O, et al. Microvascular complications in adolescents with type 1 diabetes mellitus[J]. Journal of Clinical Research in Pediatric Endocrinology, 2013, 5: 145-149.
    [11]
    DABELEA D, MAYER-DAVIS E J, SAYDAH S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009[J]. JAMA, 2014, 311(17): 1778-1786.
    [12]
    严晋华, 章燕, 郑雪瑛,等. 1型糖尿病患者胰岛素治疗方案与血糖控制的相关性[J]. 中华医学杂志, 2017, 97(8): 587-591.
    YAN Jinhua, ZHANG Yan, ZHENG Xueying, et al.Insulin regimes and impact on glycemic control in patients with type 1 diabetes[J]. National Medical Journal of China, 2017, 97(8): 587-591.
    [13]
    EPSTEIN E J, OSMAN J L, COHEN H W, et al. Use of the estimated glucose disposal rate (eGDR) as a measure of insulin resistance in an urban multiethnic population with type 1 diabetes[J]. Diabetes Care, 2013, 36(8): 2280-2285.
    [14]
    ZHENG X , HUANG B , LUO S , et al. A new model to estimate insulin resistance via clinical parameters in adults with type 1 diabetes[J]. Diabetes/Metabolism Research and Reviews, 2017, 33(4):e2880.
    [15]
    中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志, 2018, 10(1): 4-67.
    [16]
    中华医学会内分泌学分会肥胖学组. 中国成人肥胖症防治专家共识[J].中华内分泌代谢杂志, 2011, 27(9): 711-717.
    [17]
    SVENSSON M, YU Z W , ERIKSSON J W . A small reduction in glomerular filtration is accompanied by insulin resistance in type I diabetes patients with diabetic nephropathy[J]. European Journal of Clinical Investigation, 2002, 32(2): 100-109.
    [18]
    MOTTL A K, LAUER A, DABELEA D, et al. Albuminuria according to status of autoimmunity and insulin sensitivity among youth with type 1 and type 2 diabetes[J]. Diabetes Care, 2013, 36(11): 3633-3638.
    [19]
    MOTTL A K, DIVERS J, DABELEA D, et al. The dose-response effect of insulin sensitivity on albuminuria in children according to diabetes type[J]. Pediatric Nephrology, 2016, 31(6): 933-940.
    [20]
    童国玉, 朱大龙. 糖尿病肾病国内外临床指南和专家共识解读[J].中国实用内科杂志, 2017(3):32-37.
    TONG Guoyu, ZHU Dalong.Interpretation of clinical practice guidelines and expert consensuses for the evaluation and management of diabetic kidney disease at home and abroad[J]. Chinese Journal of Practical Internal Medicine, 2017(3):32-37.
    [21]
    TUTTLE K R, BAKRIS G L, BILOUS R W, et al. Diabetic kidney disease: A report from an ADA Consensus Conference[J]. American Journal of Kidney Diseases, 2014, 64(4): 510-533.
    [22]
    WADN J, FORSBLOM C, THORN L M, et al. A1C variability predicts incident cardiovascular events, microalbuminuria, and overt diabetic nephropathy in patients with type 1 diabetes[J]. Diabetes, 2009, 58(11): 2649-2655.
    [23]
    LITHOVIUS R, GORDIN D, FORSBLOM C, et al. Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes[J]. Diabetologia, 2018, 61(9): 1935-1945.)
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    [1]
    WADN J, FORSBLOM C, Thorn L M, et al. Adult stature and diabetes complications in patients with type 1 diabetes: The FinnDiane study and the diabetes control and complications trial[J]. Diabetes, 2009, 58(8): 1914-1920.
    [2]
    TONELLI M, MUNTNER P, LLOYD A, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: A population-level cohort study[J]. Lancet, 2012, 380(9844): 807-814.
    [3]
    Diabetes Prevention Program Research Group. Changes in albumin excretion in the Diabetes Prevention Program[J]. Diabetes Care, 2009, 32(4): 720-725.
    [4]
    National Kidney Foundation.KDOQI clinical practice guideline for diabetes and CKD: 2012 update[J]. American Journal of Kidney Diseases, 2012, 60(5): 850-886.
    [5]
    THORN L M, FORSBLOM C, WADN J, et al. Metabolic syndrome as a risk factor for cardiovascular disease, mortality, and progression of diabetic nephropathy in type 1 diabetes[J]. Diabetes Care, 2009, 32(5): 950-952.
    [6]
    SZADKOWSKA A,PIETRZAK I, MIANOWSKA B, et al. Insulin sensitivity in type 1 diabetic children and adolescents[J]. Diabetic Medicine, 2008, 25(3): 282-288.
    [7]
    LOVSHIN J A, KRTIC＇ M, PETTER B, et al. Hyperfiltration, urinary albumin excretion, and ambulatory blood pressure in adolescents with type 1 diabetes mellitus[J]. American Journal of Physiology-Renal Physiology, 2018, 314(4): F667-F674.
    [8]
    COSTACOU T, CRANDELL J, KAHKOSKA A R, et al. Dietary patterns over time and microalbuminuria in youth and young adults with type 1 diabetes: The SEARCH Nutrition Ancillary Study[J]. Diabetes Care, 2018, 41(8): 1615-1622.
    [9]
    MARCOVECCHIO M L, WOODSIDE J, JONES T, et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): Urinary screening and baseline biochemical and cardiovascular assessments[J]. Diabetes Care, 2014, 37: 805-813.
    [10]
    DEMIREL F, TEPE D, KARA O, et al. Microvascular complications in adolescents with type 1 diabetes mellitus[J]. Journal of Clinical Research in Pediatric Endocrinology, 2013, 5: 145-149.
    [11]
    DABELEA D, MAYER-DAVIS E J, SAYDAH S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009[J]. JAMA, 2014, 311(17): 1778-1786.
    [12]
    严晋华, 章燕, 郑雪瑛,等. 1型糖尿病患者胰岛素治疗方案与血糖控制的相关性[J]. 中华医学杂志, 2017, 97(8): 587-591.
    YAN Jinhua, ZHANG Yan, ZHENG Xueying, et al.Insulin regimes and impact on glycemic control in patients with type 1 diabetes[J]. National Medical Journal of China, 2017, 97(8): 587-591.
    [13]
    EPSTEIN E J, OSMAN J L, COHEN H W, et al. Use of the estimated glucose disposal rate (eGDR) as a measure of insulin resistance in an urban multiethnic population with type 1 diabetes[J]. Diabetes Care, 2013, 36(8): 2280-2285.
    [14]
    ZHENG X , HUANG B , LUO S , et al. A new model to estimate insulin resistance via clinical parameters in adults with type 1 diabetes[J]. Diabetes/Metabolism Research and Reviews, 2017, 33(4):e2880.
    [15]
    中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志, 2018, 10(1): 4-67.
    [16]
    中华医学会内分泌学分会肥胖学组. 中国成人肥胖症防治专家共识[J].中华内分泌代谢杂志, 2011, 27(9): 711-717.
    [17]
    SVENSSON M, YU Z W , ERIKSSON J W . A small reduction in glomerular filtration is accompanied by insulin resistance in type I diabetes patients with diabetic nephropathy[J]. European Journal of Clinical Investigation, 2002, 32(2): 100-109.
    [18]
    MOTTL A K, LAUER A, DABELEA D, et al. Albuminuria according to status of autoimmunity and insulin sensitivity among youth with type 1 and type 2 diabetes[J]. Diabetes Care, 2013, 36(11): 3633-3638.
    [19]
    MOTTL A K, DIVERS J, DABELEA D, et al. The dose-response effect of insulin sensitivity on albuminuria in children according to diabetes type[J]. Pediatric Nephrology, 2016, 31(6): 933-940.
    [20]
    童国玉, 朱大龙. 糖尿病肾病国内外临床指南和专家共识解读[J].中国实用内科杂志, 2017(3):32-37.
    TONG Guoyu, ZHU Dalong.Interpretation of clinical practice guidelines and expert consensuses for the evaluation and management of diabetic kidney disease at home and abroad[J]. Chinese Journal of Practical Internal Medicine, 2017(3):32-37.
    [21]
    TUTTLE K R, BAKRIS G L, BILOUS R W, et al. Diabetic kidney disease: A report from an ADA Consensus Conference[J]. American Journal of Kidney Diseases, 2014, 64(4): 510-533.
    [22]
    WADN J, FORSBLOM C, THORN L M, et al. A1C variability predicts incident cardiovascular events, microalbuminuria, and overt diabetic nephropathy in patients with type 1 diabetes[J]. Diabetes, 2009, 58(11): 2649-2655.
    [23]
    LITHOVIUS R, GORDIN D, FORSBLOM C, et al. Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes[J]. Diabetologia, 2018, 61(9): 1935-1945.)
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