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.