A Nation‐wide Cross‐sectional Study of Urinary Albumin Excretion Rate, Arterial Blood Pressure and Blood Glucose Control in Danish Children with Type 1 Diabetes Mellitus

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Abstract
Nation‐wide screening for microalbuminuria in Denmark was performed in 22 paediatric departments treating children with Type 1 diabetes. Over a period of 6 months 1020 children ( 12 years) and adolescents (> 12 to 19 years) were screened (81% of total). Of these, 957 (94%) performed at least two timed overnight urine collections. In 209 non‐diabetic subjects the upper 95% limit for normal albumin excretion rate (AER) was 20 μg min−1. Mean overnight AER was significantly (p < 0.001) elevated in diabetic (3.0 x/divide; 2.3 (SD tolerance factor) μg min−1) and in non‐diabetic (2.5 x/ divide; 2.2 μg min−1) adolescents compared with diabetic (1.7 x/ divide; 2.1 μg min−1) and non‐diabetic (1.3 x/ divide; 2.2 μg min−1) children. In the diabetic patients AER was positively correlated with the body surface area and age. Among the patients with Type 1 diabetes, 4.3% (18 males and 23 females) had AER > 20 to 150 μg min−1 (persistent microalbuminuria). A further 7 adolescents (0.7%) had overt proteinuria (> 150 μg min−1). Clinical data for the 41 diabetic patients with AER > 20 to 150 μg min−1 were compared with those for 569 diabetic adolescents with AER 20 μg min−1 and duration of diabetes more than 2 years. The group with AER > 20 to 150 μg min−1 had significantly higher mean age (16.5 years) than the group with AER 20 μg min−1 (15.0 years; p < 0.001). Females with AER > 20 to 150 μg min−1 had significantly higher mean HbA1c level (10.8 ± 1.9%) than those with AER 20 μg min−1 (9.8 ± 1.9%, p < 0.03); they also had impaired linear growth (standard deviation score −0.25 vs + 0.16; p = 0.003). These associations were not found in males. Mean body mass index (BMI) was significantly increased in both females (22.2 ± 2.9 kg m−2) and males (20.8 ± 2.7 kg m−2) with AER > 20 to 150 μg min−1, compared with diabetic patients with AER 20 μg min−1 (females 20.8 ± 3.0 kg m−2, p = 0.02; males 19.7 ± 2.4 kg m−2, p < 0.006). Mean blood pressure was significantly higher (94 ± 9 mmHg) in the group of diabetic patients with AER > 20 to 150 μg min−1 than in the group with AER 20 μg min−1 (87 ± 9 mmHg; p < 0.0001). No statistically significant differences in mean blood pressure or BMI were found between the diabetic patients and a control group of 663 non‐diabetic healthy children. The findings suggest that hormonal changes in puberty, poor blood glucose control (particularly in females), and elevated arterial blood pressure may be risk factors related to the increased prevalence of microalbuminuria in diabetic children.