Nephropathy risk lowered by glucose, BP control in Type 1 diabetes

By Sally Robertson, B.Sc.Apr 29 2013

Individuals with Type 1 diabetes should keep good control of their blood sugar levels and blood pressure (BP) to reduce their risk for developing nephropathy, say researchers.

Control of these factors becomes increasingly relevant as individuals age, say the researchers, who found that age and diabetes duration were significantly associated with microalbuminuria (MA) risk in a large analysis of data obtained from the T1D Exchange Clinic Network.

"Since age and diabetes duration are important nonmodifiable factors associated with MA, the importance of routine screening is underscored to ensure early diagnosis and timely treatment of MA," say Stephanie DuBose (Jaeb Center for Health Research, Tampa, Florida, USA) and colleagues.

The researchers analyzed data available for 7549 participants, aged 20 years or younger, with a diabetes duration of at least 1 year and urinary albumin-to-creatinine ratio (ACR) measured within 2 years prior.

As reported in Diabetes Care, 329 (4.4%) participants had MA, as defined by an ACR of 30mg/g or less and no known cause for nephropathy other than diabetes.

The frequency of MA was significantly associated with increasing diabetes duration and higher glycated hemoglobin (HbA1c) levels, with the highest occurrence of MA observed among those with both a longer duration and higher HbA1c levels.

Multivariate analysis showed that age, diabetes duration, female gender, elevated diastolic BP, and lower body mass index were significant risk factors for MA. The frequency of MA was highest, exceeding 15%, among individuals with a diabetes duration of at least 10 years and an HbA1c level of 9.5% or more.

By contrast, MA occurrence was infrequent among individuals with a mean HbA1c of less than 7.5%, regardless of their age or how long they had diabetes.

High blood glucose levels and increased BP are modifiable risk factors and already form the basis for the prevention of diabetic kidney disease (DKD), say et DuBose et al. "Our results provide strong support for prior literature in emphasizing the importance of good glycemic and BP control, particularly as diabetes duration increases, in order to reduce the risk of DKD."

On the other hand, age and diabetes duration are nonmodifiable risk factors and individuals should be routinely screened to ensure MA is identified and treated early on, says the team.

"Longitudinal follow-up of this cohort will provide important information with respect to the predictive value of MA for the subsequent development of impaired renal function," the researchers add.

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