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Pediatr Diabetes. 2016 Sep;17(6):398-406. doi: 10.1111/pedi.12300. Epub 2015 Sep 17.

High hemoglobin A1c variability is associated with early risk of microalbuminuria in children with T1D.

Author information

1
Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
2
Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
3
University of Kansas Medical Center, Kansas City, KS, USA.
4
Department of Research Development and Clinical Investigations, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
5
Department of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
6
Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden.
7
Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
8
Cardiovascular Services, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.

Abstract

OBJECTIVE:

To test the hypothesis that HbA1c variability, as measured by standard deviation (SD), is associated with increased risk for incident microalbuminuria and persistent microalbuminuria in pediatric type 1 diabetes (T1D).

METHODS:

A retrospective analysis using data from electronic health records was performed on 1195 patients from a pediatric diabetes clinic network in the Midwest USA from 1993 to 2009 with ≥1 yr of T1D, ≥4 total HbA1c values, ≥2 HbA1c values/yr, ≥1 urine microalbumin. Microalbuminuria, the main outcome was defined as albumin excretion rate ≥20 mcg/min or 2 of 3 consecutive urine microalbumin/creatinine ≥30 mg/gm. Patients who had persistently high microalbumin or who were treated with an angiotensin-converting-enzyme inhibitor within 1 yr were considered to have persistent microalbuminuria. Sex, race, age, diagnosis age, and duration were covariates.

RESULTS:

Median numbers of per-patient HbA1c and microalbumin results were 14 and 3, respectively. Median intrapersonal mean HbA1c and SD were 8.62% (70.72 mol/mol) and 1.47% (16.07 mmol/mol), respectively. The median interquartile range (IQR) of diagnosis age was 9.4 yr (6.26-12.02) and diabetes duration was 4.97 yr (2.93-7.64). A total of 172 patients (14.4%) developed microalbuminuria; 55 (4.6%) had persistent microalbuminuria. Patients with higher SD of HbA1c had shorter time to microalbuminuria. In time-dependent Cox Proportional Hazard models, updated SD of HbA1c was significantly associated with microalbuminuria [univariate hazard ratio (HR) 1.48 (1.25-1.76); multivariable HR 1.28 (1.04-1.58)], whereas updated mean HbA1c was not [univariate HR 1.08 (0.97-1.22); multivariable HR 1.05 (0.92-1.2)]. Patients with persistent microalbuminuria had similar HRs.

CONCLUSIONS:

HbA1c variability is independently associated with development of microalbuminuria in children with T1D, highlighting the importance of maintaining stable glycemic control in pediatric patients.

KEYWORDS:

HbA1c variability; children; microalbuminuria; nephropathy; type 1 diabetes mellitus

PMID:
26377593
DOI:
10.1111/pedi.12300
[Indexed for MEDLINE]

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