Barkai László, Rácz Olivér, Eigner György, Kovács Levente
Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia.
Physiological Controls Regulation Research Center, University Research and Innovation Center, Obuda University, Budapest, Hungary.
Diabetol Metab Syndr. 2025 May 26;17(1):173. doi: 10.1186/s13098-025-01749-x.
Albuminuria within the normal range may predict an increased risk of subsequent nephropathy in type 1 diabetes (T1D). The role of sustained hyperglycaemia in the development of nephropathy is well-known. The relationship between albuminuria within the normal range and parameters of continuous glucose monitoring (CGM) in childhood has not yet been investigated. The aim of the present study was to analyze this relationship in young T1D patients.
A total of 54 normoalbuminuric, normotensive, real time CGM user pubertal children and adolescents with T1D were recruited for this study. Patients with medium to high normal (1.0-2.9 mg/mmol; n = 18) and those with low normal (< 1.0 mg/mmol; n = 36) urinary albumin-to-creatinin ratio (UACR) were compared regarding CGM metrics data. Relationships of UACR with clinical variables and CGM-derived metrics were analysed by multiple logistic regression.
Time in range (TIR) was lower in medium to high normal UACR patients than in low normal UACR patients (mean ± SD: 58.2 ± 8.4% vs. 64.5 ± 10.1%, p = 0.0199). Patients with medium to high normal UACR had a higher coefficient of variation for mean glucose (CV) than those with low normal UACR (42.4 ± 6.0% vs. 38.0 ± 6.1%, p = 0.0163). UACR was related to TIR (r=-0.55, p = 0.02), to CV (r=-0.51, p = 0.04) and to mean glucose (MG) (r=-0.48, p = 0.05). TIR, CV and puberty proved to be independently predictive for medium to high normal UACR [adjusted RR (95% CI): 0.70 (0.58-0.92), p = 0.0231; 1.28 (1.02-1.67), p = 0.0222; 1.19 (1.10-1.36), p = 0.0321, respectively].
The duration of the blood glucose level within the target range and the extent of its fluctuation may contribute to the early increase in albumin excretion within the normal range, which may play a role in the development of later complications of childhood T1D.
正常范围内的蛋白尿可能预示1型糖尿病（T1D）患者随后发生肾病的风险增加。持续性高血糖在肾病发展中的作用是众所周知的。正常范围内的蛋白尿与儿童连续血糖监测（CGM）参数之间的关系尚未得到研究。本研究的目的是分析年轻T1D患者中的这种关系。
本研究共招募了54名正常蛋白尿、血压正常、使用实时CGM的青春期T1D儿童和青少年。比较了尿白蛋白与肌酐比值（UACR）处于中高正常范围（1.0 - 2.9mg/mmol；n = 18）和低正常范围（<1.0mg/mmol；n = 36）的患者的CGM指标数据。通过多元逻辑回归分析UACR与临床变量和CGM衍生指标之间的关系。
中高正常UACR患者的血糖达标时间（TIR）低于低正常UACR患者（均值±标准差：58.2±8.4% vs. 64.5±10.1%，p = 0.0199）。中高正常UACR患者的平均血糖变异系数（CV）高于低正常UACR患者（42.4±6.0% vs. 38.0±6.1%，p = 0.0163）。UACR与TIR（r = -0.55，p = 0.02）、CV（r = -0.51，p = 0.04）和平均血糖（MG）（r = -0.48，p = 0.05）相关。TIR、CV和青春期被证明是中高正常UACR的独立预测因素[调整后RR（95%CI）：0.70（0.58 - 0.92），p = 0.0231；1.28（1.02 - 1.67），p = 0.0222；1.19（1.10 - 1.36），p = 0.0321]。
血糖水平在目标范围内的持续时间及其波动程度可能导致正常范围内白蛋白排泄早期增加，这可能在儿童T1D后期并发症的发展中起作用。
