Diabetes Care. 2013 Jun;36(6):1735-41. doi: 10.2337/dc12-2420.
Among adolescents with type 2 diabetes, there is limited information regarding incidence and progression of hypertension and microalbuminuria. Hypertension and microalbuminuria assessments made during the TODAY clinical trial were analyzed for effect of treatment, glycemic control, sex, and race/ethnicity.
A cohort of 699 adolescents, 10-17 years of age, <2 years duration of type 2 diabetes, BMI ≥ 85%, HbA1c ≤ 8% on metformin therapy, controlled blood pressure (BP), and calculated creatinine clearance >70 mL/min, were randomized to metformin, metformin plus rosiglitazone, or metformin plus intensive lifestyle intervention. Primary study outcome was loss of glycemic control for 6 months or sustained metabolic decompensation requiring insulin. Hypertension and microalbuminuria were managed aggressively with standardized therapy to maintain BP <130/80 or <95th percentile for age, sex, and height and microalbuminuria <30 μg/mg.
In this cohort, 319 (45.6%) reached primary study outcome, and 11.6% were hypertensive at baseline and 33.8% by end of study (average follow-up 3.9 years). Male sex and higher BMI significantly increased the risk for hypertension. Microalbuminuria was found in 6.3% at baseline and rose to 16.6% by end of study. Diagnosis of microalbuminuria was not significantly different between treatment arms, sex, or race/ethnicity, but higher levels of HbA1c were significantly related to risk of developing microalbuminuria.
Prevalence of hypertension and microalbuminuria increased over time among adolescents with type 2 diabetes regardless of diabetes treatment. The greatest risk for hypertension was male sex and higher BMI. The risk for microalbuminuria was more closely related to glycemic control.
在患有 2 型糖尿病的青少年中，有关高血压和微量白蛋白尿的发病率和进展情况的信息有限。对 TODAY 临床试验中进行的高血压和微量白蛋白尿评估进行了分析，以了解治疗、血糖控制、性别和种族/民族的影响。
对 699 名年龄在 10-17 岁、2 年内患有 2 型糖尿病、BMI≥85%、二甲双胍治疗时 HbA1c≤8%、血压控制良好（BP）且估算肌酐清除率>70mL/min 的青少年进行了队列研究，这些患者被随机分为二甲双胍组、二甲双胍+罗格列酮组或二甲双胍+强化生活方式干预组。主要研究结果是 6 个月内血糖控制恶化或持续代谢失代偿需要胰岛素。通过标准治疗积极控制高血压和微量白蛋白尿，以维持血压<130/80mmHg 或<年龄、性别和身高的第 95 百分位，以及微量白蛋白尿<30μg/mg。
在该队列中，319 名（45.6%）达到了主要研究结果，11.6%的患者在基线时有高血压，33.8%的患者在研究结束时（平均随访 3.9 年）有高血压。男性和更高的 BMI 显著增加了高血压的风险。基线时有 6.3%的患者出现微量白蛋白尿，研究结束时上升至 16.6%。诊断为微量白蛋白尿在治疗组、性别或种族/民族之间无显著差异，但更高的 HbA1c 水平与发生微量白蛋白尿的风险显著相关。
无论糖尿病治疗如何，患有 2 型糖尿病的青少年中高血压和微量白蛋白尿的患病率随时间推移而增加。高血压的最大风险是男性和更高的 BMI。微量白蛋白尿的风险与血糖控制更为密切相关。
