Albuminuria According to Status of Autoimmunity and Insulin Sensitivity Among Youth With Type 1 and Type 2 Diabetes

作者:Mottl Amy K*; Lauer Abigail; Dabelea Dana; Maahs David M; D' Agostino Ralph B Jr; Dolan Larry M; Gilliam Lisa K; Lawrence Jean M; Rodriguez Beatriz; Marcovina Santica M; Imperatore Giuseppina; Shankar Roopa Kanakatti; Afkarian Maryam; Reynolds Kristi; Liese Angela D; Mauer Michael; Mayer Davis Elizabeth J
来源:Diabetes Care, 2013, 36(11): 3633-3638.
DOI:10.2337/dc13-0568

摘要

OBJECTIVETo evaluate whether etiologic diabetes type is associated with the degree of albuminuria in children with diabetes.RESEARCH DESIGN AND METHODSSEARCH is an observational, longitudinal study of children with diabetes. Youth with newly diagnosed diabetes were classified according to diabetes autoantibody (DAA) status and presence of insulin resistance. We defined insulin resistance as an insulin sensitivity score %26lt;25th percentile for the United States general youth population. DAA status was based on positivity for the 65-kD isoform of glutamate decarboxylase and insulinoma-associated protein 2 antigens. The four etiologic diabetes type groups were as follows: DAA(+)/insulin-sensitive (IS) (n = 1,351); DAA(+)/insulin-resistant (IR) (n = 438); DAA(-)/IR (n = 379); and DAA(-)/IS (n = 233). Urinary albumin:creatinine ratio (UACR) was measured from a random urine specimen. Multivariable regression analyses assessed the independent relationship between the four diabetes type groups and magnitude of UACR.RESULTSAdjusted UACR means across the four groups were as follows: DAA(+)/IS = 154 g/mg; DAA(+)/IR = 137 g/mg; DAA(-)/IR = 257 g/mg; and DAA(-)/IS = 131 g/mg (P %26lt; 0.005). Only DAA(-)/IR was significantly different. We performed post hoc multivariable regression analysis restricted to the two IR groups to explore the contribution of DAA status and insulin sensitivity (continuous) to the difference in UACR between the IR groups. Only insulin sensitivity was significantly associated with UACR ( = -0.54; P %26lt; 0.0001).CONCLUSIONSIn youth with diabetes, the DAA(-)/IR group had a greater UACR than all other groups, possibly because of the greater magnitude of insulin resistance. Further exploration of the relationships between severity of insulin resistance, autoimmunity, and albuminuria in youth with diabetes is warranted.

  • 出版日期2013-11