Paediatric T2DM: Prevalence of microalbuminuria doubles within 2 years of diagnosis

06 Sep 2024 bởiNatalia Reoutova
Paediatric T2DM: Prevalence of microalbuminuria doubles within 2 years of diagnosis

Data from the Hong Kong Childhood Diabetes Registry (HKCDR) show that 2 years after diagnosis of paediatric type 2 diabetes mellitus (T2DM), approximately 20–65 percent of patients have ≥1 of the following: microalbuminuria (MA), suboptimal glycaemic control, hypertension, or dyslipidaemia.

Paediatric T2DM (ie, diagnosed <18 years of age) is becoming increasingly common worldwide. In Hong Kong, its crude incidence rate increased from 1.27 per 100,000 person-years (PYs) in 1997–2007 to 3.42 per 100,000 PYs in 2008–2017. [Pediatr Diabetes 2022;23:556-561] “In this study, we reviewed the glycaemic control findings and microvascular complication rates among recently diagnosed paediatric T2DM patients in Hong Kong, with a focus on outcomes at 2 years after diagnosis, and sought to identify factors associated with poor glycaemic control and development of MA,” wrote the researchers. [Hong Kong Med J 2024;30:291-299]

A total of 212 paediatric patients were diagnosed with T2DM between 2014 and 2018 and recruited into HKCDR. Of these patients, 71.3 percent had a family history of T2DM and 21.7 percent were symptomatic at diagnosis; 67.5 percent continued follow-up 2 years after diagnosis.

The median level of HbA1c was 7.5 percent at baseline, 6.3 percent 1 year after diagnosis and 6.5 percent 2 years after diagnosis. Suboptimal glycaemic control was reported in 65.5, 29.0 and 40.7 percent of patients at diagnosis, 1 year and 2 years after diagnosis, respectively.

The researchers suggested that better glycaemic control following diagnosis observed in this study’s cohort vs that reported in previous studies could be due to lower HbA1c levels at diagnosis, which is consistent with most patients (78.3 percent) being asymptomatic at baseline. [PLoS One 2019;14:e0219144; Paediatr Diabetes 2018;19:1393-1399; J Paediatr 2017;188:173-80.e1]

“Our study also showed that patients with a higher initial HbA1c level tended to have a persistently high HbA1c level at 2 years. These findings emphasize the importance of early diagnosis and treatment before patients develop clinically significant hyperglycaemia, which makes diabetes more difficult to control,” they wrote.

At baseline, 76.4 percent of patients had dyslipidaemia, which decreased to 65.3 percent at 2 years. On the contrary, the proportion of patients with hypertension increased from 21.2 percent at diagnosis to 38.5 percent at 2 years.

While diabetic retinopathy (1.8 percent) and neuropathy (0.9 percent) were rare in the study’s cohort, the proportion of patients with MA increased from 9.0 percent at diagnosis to 18.6 percent at 2 years. “The increasing trend is concerning, particularly because MA has been identified as an independent predictor of mortality risk in adults,” commented the researchers. [Lancet 2010;375:2073-2081]

Further analysis revealed that patients with MA had higher HbA1c levels at 2 years vs patients without MA (median HbA1c level, 7.2 vs 6.4 percent; p=0.037). Dyslipidaemia at 2 years was associated with MA at 2 years in univariate analysis, but the effect did not remain statistically significant after adjusting for glycaemic control at 2 years. The presence of hypertension at 2 years was a risk factor for MA at 2 years and was independent of glycaemic control at 2 years (adjusted odds ratio, 4.61; p=0.008). “These results highlight the importance of early diagnosis [of paediatric T2DM] and holistic management, including comorbidity management,” concluded the researchers.