Longitudinal relation between limited joint mobility, height, insulin-like growth factor 1 levels, and risk of developing microalbuminuria: the Oxford Regional Prospective Study
- 1University Department of Paediatrics, Addenbrookes Hospital, Cambridge, UK
- 2Children Nationwide Kidney Research Laboratory, Guy’s Hospital, London, UK
- Correspondence to:
Prof. D B Dunger
University Department of Paediatrics, Box 116, Level 8, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, UK; dbd25cam.ac.uk
- Accepted 6 April 2005
Abstract
Aims: To determine risk factors for development of microalbuminuria (MA) in relation to detection of limited joint mobility (LJM+) of the interphalangeal joints in a longitudinal cohort of type 1 diabetic (T1DM) subjects.
Methods: A total of 479 T1DM subjects diagnosed <16 years were followed from diagnosis of diabetes with annual assessments consisting of assessment of LJM, measurement of HbA1c and insulin-like growth factor 1 (IGF-1), and three urine samples for albumin:creatinine ratio (ACR).
Results: After a median follow up of 10.9 years, 162 subjects (35.1%) developed LJM at median age 13.0 years and duration 5.2 years. More subjects developed LJM after compared to before puberty (67.6 v 32.4%). In LJM+ compared to LJM− subjects, HbA1c (mean 10.1 (SD 1.6) v 9.6 (1.4) %)) and ACR levels (median 1.1 (range 0.2–242.9) v 0.9 (0.4–70.7) mg/mmol) were higher, and in a Cox model probability of developing LJM was related to puberty and higher HbA1c levels. ACR levels were higher after detection of LJM compared to before (median 1.2 (range 0.4–102.6) v 0.8 (0.2–181.9) mg/mmol). Probability of developing MA was related to puberty, HbA1c, female sex, and presence of LJM (a 1.9-fold increased risk). Both LJM and MA were associated with lower height SDS (LJM: mean 0.0 (SD 1.0) v 0.2 (1.1); MA: 0.0 (1.0) v 0.2 (SD 1.0)) and lower IGF-1 levels.
Conclusion: The development of LJM was associated with an increased risk of microalbuminuria, independent of glycaemic control. Risk for both microalbuminuria and LJM was associated with puberty, reduced growth, and reduced IGF-1 levels, and may indicate underlying shared pathogenic mechanisms.
- ACR, albumin:creatinine ratio
- BP, blood pressure
- CV, coefficient of variation
- GH, growth hormone
- IGF-1, insulin-like growth factor 1
- LJM, limited joint mobility
- MA, microalbuminuria
- ORPS, Oxford Regional Prospective Study
- SDS, standard deviation score
- T1DM, type 1 diabetes mellitus
Footnotes
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Competing interests: none declared
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Consent was obtained for publication of figure 1
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Members of the Oxford Regional Prospective Study Steering Committee are: DB Dunger, RN Dalton, J Fuller, EAM Gale, H Keen, M Murphy, HAW Niel, CJ Schultz, RJ Young, and T Konopelska-Bahu
Members of the Oxford Regional Prospective Study are: JA Edge, John Radcliffe Hospital, Oxford; HAW Niel and David Matthews, The Oxford Centre for Diabetes, Endocrinology and Metabolism, The Churchill Hospital, Oxford; RAF Bell and A Taylor, Horton General Hospital, Banbury; A Mukhtar, BP O’Malley, BR Silk, and EH Smith, Kettering District Hospital, Kettering; RDM Scott, King Edward VII Hospital; FM Ackland, CJ Fox, and NK Griffin, Northampton General Hospital; N Mann, H Simpson, P Cove Smith, and M Pollitzer, Royal Berkshire Hospital, Reading; RS Brown and AH Knight, Stoke Mandeville Hospital, Aylesbury; JM Cowen and JC Pearce, Wexham Park Hospital, Slough
