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Unchanged incidence of Microalbuminuria in Children with Type 1 Diabetes since 1986: A UK based inception cohort
  1. Rakesh Amin (aminrak{at}gmail.com)
  1. University Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
    1. Barry Widmer (bw215{at}cam.ac.uk)
    1. University Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
      1. Neil Dalton (neil.dalton{at}kcl.ac.uk)
      1. WellChild Laboratory, King's College London, Guy's Hospital, London, United Kingdom
        1. David B Dunger (dbd25{at}cam.ac.uk)
        1. University Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom

          Abstract

          Aims: To prospectively determine the change in prevalence of microalbuminuria (MA) in relation to changes in glycaemic control in children diagnosed with type 1 diabetes between 1986 and 1996.

          Design: Prospective observational study of an inception cohort

          Setting: The geographically defined region of Oxfordshire, UK

          Patients: 527 children diagnosed with type 1 diabetes under age 16 years, divided into three groups based on year of diagnosis of diabetes; group A (1986 to 1989, n=165); group B (1989 to 1993, n=179) and group C (1993 to 1996, n=183). Each group was followed prospectively for 10 years.

          Main outcome measures: Cumulative prevalence of MA

          Results: After 4052 patient years of follow-up, in groups C v B v A; the cumulative prevalence of MA was 31.7% [95% confidence interval 20.9 to 42.5], 24.8% [17.8 to 31.8] and 23.2% [15.4 to 30.0], (Log Rank P=0.22) and risk for development of MA was not associated with year of onset of diabetes (Hazard Ratio 1.05 [0.99 to 1.12], P=0.11). In groups C v B v A, glycaemic control improved after ten years of diabetes (Mean HbA1c 8.9 (1.5) v 9.4 (1.5) v 10.1 (1.7)%, P-value for ANOVA<0.001) and more children achieved an HbA1c level <7.5% (15.6 v 5.9 v 6.1%, P-value for ANOVA=0.032).

          Conclusion: In this UK based inception cohort of children diagnosed with type 1 diabetes, adjusted prevalence of MA was unchanged since 1986, despite some improvements in glycaemic control. This observation highlights the need for more proactive intervention with drugs such as ACE Inhibitors.

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