Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Diabetol. 2022 Jun;59(6):761-772. doi: 10.1007/s00592-022-01863-6. Epub 2022 Feb 24.
Albuminuria is strongly associated with risk of renal dysfunction, cardiovascular disease and mortality. However, clinical guidelines diverge, and evidence is sparse on what risk factor levels regarding blood pressure, blood lipids and BMI are needed to prevent albuminuria in adolescents and young adults with type 1 diabetes.
A total of 9347 children and adults with type 1 diabetes [mean age 15.3 years and mean diabetes duration 1.4 years at start of follow-up] from The Swedish National Diabetes Registry were followed from first registration until end of 2017. Levels for risk factors for a risk increase in nephropathy were evaluated, and the gradient of risk per 1 SD (standard deviation) was estimated to compare the impact of each risk factor.
During the follow-up period, 8610 (92.1%) remained normoalbuminuric, 737 (7.9%) individuals developed micro- or macroalbuminuria at any time period of whom 132 (17.9% of 737) individuals developed macroalbuminuria. Blood pressure ≥ 140/80 mmHg was associated with increased risk of albuminuria (p ≤ 0.0001), as were triglycerides ≥ 1.0 mmol/L (p = 0.039), total cholesterol ≥ 5.0 mmol/L (p = 0.0003), HDL < 1.0 mmol/L (p = 0.013), LDL 3.5- < 4.0 mmol/L (p = 0.020), and BMI ≥ 30 kg/m (p = 0.033). HbA1c was the strongest risk factor for any albuminuria estimated by the measure gradient of risk per 1 SD, followed by diastolic blood pressure, triglycerides, systolic blood pressure, cholesterol and LDL. In patients with HbA1c > 65 mmol/mol (> 8.1%), blood pressure > 140/70 mmHg was associated with increased risk of albuminuria.
Preventing renal complications in adolescents and young adults with type 1 diabetes need avoidance at relatively high levels of blood pressure, blood lipids and BMI, whereas very tight control is not associated with further risk reduction. For patients with long-term poor glycaemic control, stricter blood pressure control is advocated.
蛋白尿与肾功能障碍、心血管疾病和死亡率的风险密切相关。然而，临床指南存在分歧，关于血压、血脂和 BMI 的危险因素水平需要达到什么程度才能预防 1 型糖尿病青少年和年轻人的蛋白尿，这方面的证据很少。
共纳入 9347 例来自瑞典国家糖尿病登记处的 1 型糖尿病儿童和成人（平均年龄 15.3 岁，随访开始时平均糖尿病病程为 1.4 年），从首次登记开始随访至 2017 年底。评估了肾病风险增加的危险因素水平，并估计了每标准差（SD）的风险梯度，以比较每个危险因素的影响。
在随访期间，8610 例（92.1%）保持正常白蛋白尿，737 例（7.9%）在任何时间段出现微量或大量白蛋白尿，其中 132 例（737 例的 17.9%）出现大量白蛋白尿。血压≥140/80mmHg 与蛋白尿风险增加相关（p≤0.0001），甘油三酯≥1.0mmol/L（p=0.039）、总胆固醇≥5.0mmol/L（p=0.0003）、高密度脂蛋白<1.0mmol/L（p=0.013）、LDL 3.5-<4.0mmol/L（p=0.020）和 BMI≥30kg/m（p=0.033）也是如此。HbA1c 是估计每标准差风险梯度的任何蛋白尿的最强危险因素，其次是舒张压、甘油三酯、收缩压、胆固醇和 LDL。在 HbA1c>65mmol/mol（>8.1%）的患者中，血压>140/70mmHg 与蛋白尿风险增加相关。
预防 1 型糖尿病青少年和年轻人的肾脏并发症需要避免相对较高水平的血压、血脂和 BMI，而非常严格的控制与进一步降低风险无关。对于长期血糖控制不佳的患者，提倡更严格的血压控制。
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