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The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes.

ABSTRACT: AIMS:To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression. METHODS:Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N?=?1316) and type 2 diabetes (N?=?143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7?years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ?30??g/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ?30??g/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression). RESULTS:Albuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR)?=?1.3, 95% CI 1.1-1.6) and lack of private health insurance (aOR?=?2.7, 95%CI 1.1-6.5) in type 1 diabetes; and African American race (OR?=?4.6, 95% CI 1.2-14.2), lower estimated insulin sensitivity score (aOR?=?2.1, 95% CI 1.4-3.3), baseline UACR (aOR?=?3.2, 95% CI 1.7-5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR?=?1.3, 95% CI 1.0, 1.5) in type 2 diabetes. CONCLUSIONS:In the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Early interventions may help reduce long-term kidney complications.

SUBMITTER: Kahkoska AR

PROVIDER: S-EPMC6289668 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes.

Kahkoska Anna R AR Isom Scott S Divers Jasmin J Mayer-Davis Elizabeth J EJ Dolan Lawrence L Shah Amy S AS Afkarian Maryam M Pettitt David J DJ Lawrence Jean M JM Marcovina Santica S Saydah Sharon H SH Dabelea Dana D Maahs David M DM Mottl Amy K AK

Journal of diabetes and its complications 20181004 12

<h4>Aims</h4>To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression.<h4>Methods</h4>Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N = 1316) and type 2 diabetes (N = 143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7 years later). Albuminuria regression was ...[more]

PMID: 30316542

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Project description:ImportanceYouth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions.ObjectiveTo identify psychosocial factors associated with glycated hemoglobin (HbA1c) levels in young adults with youth-onset type 2 diabetes.Design, setting, and participantsFor the iCount cohort study, HbA1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023.Main outcomes and measuresGlycemic control was examined categorically (high [≥8.0%] vs low [<8.0%] HbA1c), continuously (HbA1c level), and over time (change in HbA1c: decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA1c of 8.0% or greater, T2 HbA1c level, and change in HbA1c.ResultsOf the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA1c at T2. Diabetes distress was associated with higher HbA1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA1c decrease of at least 0.5% over 1 year.Conclusions and relevanceIn this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.

Dataset Information

The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes.

Publications

The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes.

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