According to the results of a new study, hypertension and elevated cholesterol, as well as longer disease duration, elevated HbA1c level, and male gender, are all significant risk factors for diabetic nephropathy in patients with type 1 diabetes. Dr. Klemens Raile, from Charite Children’s Hospital in Berlin stated that, "Diabetes care must continue to focus on improvement of metabolic control, but also on monitoring of serum lipids and blood pressure. Hypertension and dyslipidemia should be treated as soon as diagnosed. "Our study is in agreement with other studies showing decreasing prevalence/incidence of nephropathy with lower long-term HbA1c."
The current analysis involved data from 27,805 patients included in the nationwide, prospective German Diabetes Documentation System survey. The median ages at diagnosis and at last visit were 9.94 and 16.34 years, respectively, while the median follow-up time was 2.5 years.
Overall, 26,605 subjects had normal urine analysis test results, 919 had microalbuminuria, 78 had macroalbuminuria, and 203 had end-stage renal disease (ESRD), the report indicates.
Based on Kaplan-Mayer hazard analysis, with a diabetes duration of 40 years, the calculated rate of microalbuminuria was 25.4% and the rate of macroalbuminuria or ESRD was 9.4%.
Significant predictors of microalbuminuria included longer diabetes duration, elevated HbA1c level, elevated LDL cholesterol level, and hypertension, the researchers found. By contrast, young age at diabetes onset was tied to a reduced risk of microalbuminuria, which is consistent with findings from earlier studies.
Male gender was identified as risk factor for macroalbuminuria, the report indicates.
"We are very pleased that the rate of renal disease, and (particularly) ESRD is relatively low," Dr. Raile said. However, "we found it alarming that co-risk factors dyslipidemia and hypertension" are often not treated adequately.
The team concludes, "Early diagnosis and treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes."
Diabetes Care 2007;30:2523-2528.