Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort
Aims/hypothesis We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control. Methods This was a prospe...
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| Veröffentlicht in: | Diabetologia 2022-05, Vol.65 (5), p.872-878 |
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| creator | Benitez-Aguirre, Paul Z. Marcovecchio, M. Loredana Chiesa, Scott T. Craig, Maria E. Wong, Tien Y. Davis, Elizabeth A. Cotterill, Andrew Couper, Jenny J. Cameron, Fergus J. Mahmud, Farid H. Neil, H. Andrew W. Jones, Timothy W. Hodgson, Lauren A. B. Dalton, R. Neil Marshall, Sally M. Deanfield, John Dunger, David B. Donaghue, Kim C. |
| description | Aims/hypothesis
We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control.
Methods
This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log
10
ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA
1c
, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable.
Results
At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3],
p
=0.001), higher mean IFCC HbA
1c
(HR 1.03 [1.01, 1.04],
p=
0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89],
p
=0.01) were independently associated with 3DR risk.
Conclusions/interpretation
High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies.
Trial registration
isrctn.org
ISRCTN91419926.
Graphical abstract |
| doi_str_mv | 10.1007/s00125-022-05661-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8960571</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2644218144</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-2549196c193996db367d9425ad2d5a0f6f3b70831215f441aee5bdcf821449613</originalsourceid><addsrcrecordid>eNp9kstu1DAUhiMEotPCC7BAltiURajvSVggjYbbSJWQ0FRiZzmxM3HJ2FPbqTTvx4P1hCnlsmCTi8_n__zn6C-KFwS_IRhXFwljQkWJKS2xkJKU5FGxIJzBL6f142Ix10tSy28nxWlK1xhjJrh8WpwwQWpKRL0oflxF53U8ID220875iy5anZ133qIIHwFlG7MbbUL7aI3rMooufUehR8bp1mbXoQhPH_Y6DweAwjbalFzwb5FGXucp6hENLuUAXVKezAH1MexQHixamgDKnfUZrXQ0LpRfrQd87aHrLRyDDNpEB0fnS_N-vXmNQpugNDubwS4MIeZnxZNej8k-v3-fFVcfP2xWn8vLL5_Wq-Vl2fGK55IK3pBGdqRhTSNNy2RlGk6FNtQIjXvZs7bCNSOwmp5zoq0Vrel6WBXnjSTsrHh31N1P7c6a2TcMp_bR7WCFKmin_q54N6htuFV1I7GoZoHze4EYbiabsto5GH8ctbdhSopKhhtKcMUBffUPeh2mCDPPFOeU1GAKKHqkuhhSirZ_MEOwmkOijiFREBL1MyRqdvHyzzEervxKBQDsCCQo-a2Nv3v_R_YOB8HMnw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2644218144</pqid></control><display><type>article</type><title>Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Benitez-Aguirre, Paul Z. ; Marcovecchio, M. Loredana ; Chiesa, Scott T. ; Craig, Maria E. ; Wong, Tien Y. ; Davis, Elizabeth A. ; Cotterill, Andrew ; Couper, Jenny J. ; Cameron, Fergus J. ; Mahmud, Farid H. ; Neil, H. Andrew W. ; Jones, Timothy W. ; Hodgson, Lauren A. B. ; Dalton, R. Neil ; Marshall, Sally M. ; Deanfield, John ; Dunger, David B. ; Donaghue, Kim C.</creator><creatorcontrib>Benitez-Aguirre, Paul Z. ; Marcovecchio, M. Loredana ; Chiesa, Scott T. ; Craig, Maria E. ; Wong, Tien Y. ; Davis, Elizabeth A. ; Cotterill, Andrew ; Couper, Jenny J. ; Cameron, Fergus J. ; Mahmud, Farid H. ; Neil, H. Andrew W. ; Jones, Timothy W. ; Hodgson, Lauren A. B. ; Dalton, R. Neil ; Marshall, Sally M. ; Deanfield, John ; Dunger, David B. ; Donaghue, Kim C. ; Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) ; on behalf of the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</creatorcontrib><description>Aims/hypothesis
We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control.
Methods
This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log
10
ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA
1c
, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable.
Results
At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3],
p
=0.001), higher mean IFCC HbA
1c
(HR 1.03 [1.01, 1.04],
p=
0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89],
p
=0.01) were independently associated with 3DR risk.
Conclusions/interpretation
High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies.
Trial registration
isrctn.org
ISRCTN91419926.
Graphical abstract</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-022-05661-1</identifier><identifier>PMID: 35182158</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adolescents ; Albumin ; Albumins - analysis ; Albuminuria ; Child ; Cholesterol ; Creatinine ; Creatinine - urine ; Diabetes ; Diabetes mellitus (insulin dependent) ; Diabetes Mellitus, Type 1 - complications ; Diabetic Nephropathies ; Diabetic nephropathy ; Diabetic Retinopathy ; Human Physiology ; Humans ; Internal Medicine ; Low density lipoprotein ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Observational studies ; Retinopathy ; Risk Factors ; Short Communication ; Teenagers</subject><ispartof>Diabetologia, 2022-05, Vol.65 (5), p.872-878</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-2549196c193996db367d9425ad2d5a0f6f3b70831215f441aee5bdcf821449613</citedby><cites>FETCH-LOGICAL-c474t-2549196c193996db367d9425ad2d5a0f6f3b70831215f441aee5bdcf821449613</cites><orcidid>0000-0002-7687-2898</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00125-022-05661-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00125-022-05661-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35182158$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Benitez-Aguirre, Paul Z.</creatorcontrib><creatorcontrib>Marcovecchio, M. Loredana</creatorcontrib><creatorcontrib>Chiesa, Scott T.</creatorcontrib><creatorcontrib>Craig, Maria E.</creatorcontrib><creatorcontrib>Wong, Tien Y.</creatorcontrib><creatorcontrib>Davis, Elizabeth A.</creatorcontrib><creatorcontrib>Cotterill, Andrew</creatorcontrib><creatorcontrib>Couper, Jenny J.</creatorcontrib><creatorcontrib>Cameron, Fergus J.</creatorcontrib><creatorcontrib>Mahmud, Farid H.</creatorcontrib><creatorcontrib>Neil, H. Andrew W.</creatorcontrib><creatorcontrib>Jones, Timothy W.</creatorcontrib><creatorcontrib>Hodgson, Lauren A. B.</creatorcontrib><creatorcontrib>Dalton, R. Neil</creatorcontrib><creatorcontrib>Marshall, Sally M.</creatorcontrib><creatorcontrib>Deanfield, John</creatorcontrib><creatorcontrib>Dunger, David B.</creatorcontrib><creatorcontrib>Donaghue, Kim C.</creatorcontrib><creatorcontrib>Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</creatorcontrib><creatorcontrib>on behalf of the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</creatorcontrib><title>Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>Aims/hypothesis
We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control.
Methods
This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log
10
ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA
1c
, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable.
Results
At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3],
p
=0.001), higher mean IFCC HbA
1c
(HR 1.03 [1.01, 1.04],
p=
0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89],
p
=0.01) were independently associated with 3DR risk.
Conclusions/interpretation
High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies.
Trial registration
isrctn.org
ISRCTN91419926.
Graphical abstract</description><subject>Adolescent</subject><subject>Adolescents</subject><subject>Albumin</subject><subject>Albumins - analysis</subject><subject>Albuminuria</subject><subject>Child</subject><subject>Cholesterol</subject><subject>Creatinine</subject><subject>Creatinine - urine</subject><subject>Diabetes</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Diabetes Mellitus, Type 1 - complications</subject><subject>Diabetic Nephropathies</subject><subject>Diabetic nephropathy</subject><subject>Diabetic Retinopathy</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Low density lipoprotein</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Observational studies</subject><subject>Retinopathy</subject><subject>Risk Factors</subject><subject>Short Communication</subject><subject>Teenagers</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kstu1DAUhiMEotPCC7BAltiURajvSVggjYbbSJWQ0FRiZzmxM3HJ2FPbqTTvx4P1hCnlsmCTi8_n__zn6C-KFwS_IRhXFwljQkWJKS2xkJKU5FGxIJzBL6f142Ix10tSy28nxWlK1xhjJrh8WpwwQWpKRL0oflxF53U8ID220875iy5anZ133qIIHwFlG7MbbUL7aI3rMooufUehR8bp1mbXoQhPH_Y6DweAwjbalFzwb5FGXucp6hENLuUAXVKezAH1MexQHixamgDKnfUZrXQ0LpRfrQd87aHrLRyDDNpEB0fnS_N-vXmNQpugNDubwS4MIeZnxZNej8k-v3-fFVcfP2xWn8vLL5_Wq-Vl2fGK55IK3pBGdqRhTSNNy2RlGk6FNtQIjXvZs7bCNSOwmp5zoq0Vrel6WBXnjSTsrHh31N1P7c6a2TcMp_bR7WCFKmin_q54N6htuFV1I7GoZoHze4EYbiabsto5GH8ctbdhSopKhhtKcMUBffUPeh2mCDPPFOeU1GAKKHqkuhhSirZ_MEOwmkOijiFREBL1MyRqdvHyzzEervxKBQDsCCQo-a2Nv3v_R_YOB8HMnw</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>Benitez-Aguirre, Paul Z.</creator><creator>Marcovecchio, M. Loredana</creator><creator>Chiesa, Scott T.</creator><creator>Craig, Maria E.</creator><creator>Wong, Tien Y.</creator><creator>Davis, Elizabeth A.</creator><creator>Cotterill, Andrew</creator><creator>Couper, Jenny J.</creator><creator>Cameron, Fergus J.</creator><creator>Mahmud, Farid H.</creator><creator>Neil, H. Andrew W.</creator><creator>Jones, Timothy W.</creator><creator>Hodgson, Lauren A. B.</creator><creator>Dalton, R. Neil</creator><creator>Marshall, Sally M.</creator><creator>Deanfield, John</creator><creator>Dunger, David B.</creator><creator>Donaghue, Kim C.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7687-2898</orcidid></search><sort><creationdate>20220501</creationdate><title>Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort</title><author>Benitez-Aguirre, Paul Z. ; Marcovecchio, M. Loredana ; Chiesa, Scott T. ; Craig, Maria E. ; Wong, Tien Y. ; Davis, Elizabeth A. ; Cotterill, Andrew ; Couper, Jenny J. ; Cameron, Fergus J. ; Mahmud, Farid H. ; Neil, H. Andrew W. ; Jones, Timothy W. ; Hodgson, Lauren A. B. ; Dalton, R. Neil ; Marshall, Sally M. ; Deanfield, John ; Dunger, David B. ; Donaghue, Kim C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-2549196c193996db367d9425ad2d5a0f6f3b70831215f441aee5bdcf821449613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adolescent</topic><topic>Adolescents</topic><topic>Albumin</topic><topic>Albumins - analysis</topic><topic>Albuminuria</topic><topic>Child</topic><topic>Cholesterol</topic><topic>Creatinine</topic><topic>Creatinine - urine</topic><topic>Diabetes</topic><topic>Diabetes mellitus (insulin dependent)</topic><topic>Diabetes Mellitus, Type 1 - complications</topic><topic>Diabetic Nephropathies</topic><topic>Diabetic nephropathy</topic><topic>Diabetic Retinopathy</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Low density lipoprotein</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Observational studies</topic><topic>Retinopathy</topic><topic>Risk Factors</topic><topic>Short Communication</topic><topic>Teenagers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Benitez-Aguirre, Paul Z.</creatorcontrib><creatorcontrib>Marcovecchio, M. Loredana</creatorcontrib><creatorcontrib>Chiesa, Scott T.</creatorcontrib><creatorcontrib>Craig, Maria E.</creatorcontrib><creatorcontrib>Wong, Tien Y.</creatorcontrib><creatorcontrib>Davis, Elizabeth A.</creatorcontrib><creatorcontrib>Cotterill, Andrew</creatorcontrib><creatorcontrib>Couper, Jenny J.</creatorcontrib><creatorcontrib>Cameron, Fergus J.</creatorcontrib><creatorcontrib>Mahmud, Farid H.</creatorcontrib><creatorcontrib>Neil, H. Andrew W.</creatorcontrib><creatorcontrib>Jones, Timothy W.</creatorcontrib><creatorcontrib>Hodgson, Lauren A. B.</creatorcontrib><creatorcontrib>Dalton, R. Neil</creatorcontrib><creatorcontrib>Marshall, Sally M.</creatorcontrib><creatorcontrib>Deanfield, John</creatorcontrib><creatorcontrib>Dunger, David B.</creatorcontrib><creatorcontrib>Donaghue, Kim C.</creatorcontrib><creatorcontrib>Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</creatorcontrib><creatorcontrib>on behalf of the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Benitez-Aguirre, Paul Z.</au><au>Marcovecchio, M. Loredana</au><au>Chiesa, Scott T.</au><au>Craig, Maria E.</au><au>Wong, Tien Y.</au><au>Davis, Elizabeth A.</au><au>Cotterill, Andrew</au><au>Couper, Jenny J.</au><au>Cameron, Fergus J.</au><au>Mahmud, Farid H.</au><au>Neil, H. Andrew W.</au><au>Jones, Timothy W.</au><au>Hodgson, Lauren A. B.</au><au>Dalton, R. Neil</au><au>Marshall, Sally M.</au><au>Deanfield, John</au><au>Dunger, David B.</au><au>Donaghue, Kim C.</au><aucorp>Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</aucorp><aucorp>on behalf of the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2022-05-01</date><risdate>2022</risdate><volume>65</volume><issue>5</issue><spage>872</spage><epage>878</epage><pages>872-878</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>Aims/hypothesis
We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control.
Methods
This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log
10
ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA
1c
, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable.
Results
At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3],
p
=0.001), higher mean IFCC HbA
1c
(HR 1.03 [1.01, 1.04],
p=
0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89],
p
=0.01) were independently associated with 3DR risk.
Conclusions/interpretation
High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies.
Trial registration
isrctn.org
ISRCTN91419926.
Graphical abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35182158</pmid><doi>10.1007/s00125-022-05661-1</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7687-2898</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-186X |
| ispartof | Diabetologia, 2022-05, Vol.65 (5), p.872-878 |
| issn | 0012-186X 1432-0428 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8960571 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adolescent Adolescents Albumin Albumins - analysis Albuminuria Child Cholesterol Creatinine Creatinine - urine Diabetes Diabetes mellitus (insulin dependent) Diabetes Mellitus, Type 1 - complications Diabetic Nephropathies Diabetic nephropathy Diabetic Retinopathy Human Physiology Humans Internal Medicine Low density lipoprotein Medicine Medicine & Public Health Metabolic Diseases Observational studies Retinopathy Risk Factors Short Communication Teenagers |
| title | Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort |
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