Identifying Risk for Microalbuminuria in Children With Type 1 Diabetes

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Increases in urine ACR were predicted by enhanced cardiovascular reflexes at baseline in pediatric patients with childhood-onset T1D.
Increases in urine ACR were predicted by enhanced cardiovascular reflexes at baseline in pediatric patients with childhood-onset T1D.

Pediatric patients diagnosed with type 1 diabetes (T1D) who demonstrate enhanced baseline cardiovascular reflexes may be at higher risk for increased urine albumin-creatinine ratio (ACR) occurring over time, according to a study published in Pediatric Diabetes.

From the Oxford Regional Prospective Study, researchers identified 199 children diagnosed with T1D (average age 8.8 years). Participants underwent baseline autonomic function testing of their heart rate (HR) in response to Valsalva maneuver, deep breathing, and standing. Baseline response of their blood pressure to standing was also recorded.

The study participants were then followed over the course of 8.6±3.4 years, with hemoglobin A1c and ACR assessed periodically. The purpose of the study was to determine, “the potential role of cardiovascular autonomic dysfunction in the development of renal complications in young people with T1D.”

An increase in ACR of 2.16% [95% CI, 0.08; 4.28, P =.04) and 2.55% [95% CI, 0.37; 4.77, P =.02) was found per year for each standard deviation increase in HR as a response to the Valsalva maneuver and increase in diastolic blood pressure in response to standing, respectively. In addition, each standard deviation increase in HR in response to standing was -2.07% [95% CI, -4.11; 0.01] per year.

Glycemic control in this study group was higher than the recommended values for adolescents, and may have both influenced the results of the study and limited the generalizability of the study findings.

Researchers concluded that increase in urine ACR was predicted by enhanced cardiovascular reflexes at baseline in a predominantly normoalbuminuric cohort of pediatric patients with childhood-onset T1D.

Early identification of individuals at a higher risk for microalbuminuria and diabetic nephropathy developing over time may provide clinicians with the opportunity to implement beneficial early interventions.

Reference

Lu L, Marcovecchio ML, Dalton RN, Dunger D. Cardiovascular autonomic dysfunction predicts increasing albumin excretion in type 1 diabetes [published online November 24, 2017]. Pediatr Diabetes. doi: 10.1111/pedi.12614

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