Effects of Metabolic Factors, Race-Ethnicity, and Sex on the Development of Nephropathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study

TODAY Study Group

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

OBJECTIVE To describe the longitudinal effects of sex, race-ethnicity, and metabolic factors on the risk of developing diabetic kidney disease (DKD) in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort. RESEARCH DESIGN AND METHODS Urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) by serum creatinine and cystatin C were assessed annually for up to 15 years after study entry. Markers of DKD included micro-and macroalbuminuria (UACR ‡30 mg/g and ‡300 mg/g, respectively), hyperfiltration (eGFR ‡135 mL/ min/1.73 m2 ), and rapid eGFR annual decline (>3 mL/min/1.73 m2 and/or ‡3.3%). The relationships between risk factors and DKD were evaluated longitu-dinally using time-to-event models. RESULTS Data were available on 677 participants, average age at baseline 14 years, with a mean ± SD follow-up of 10.2 ± 4.5 years. Each 1% increment in HbA1c conferred higher risk of microalbuminuria (hazard ratio 1.24 [95% CI 1.18, 1.30]), macroal-buminuria (1.22, [1.11, 1.34]), hyperfiltration (1.11, [1.05, 1.17]), and rapid eGFR decline (1.12, [1.04, 1.20]). No sex or race-ethnicity differences were observed for the 14-year cumulative incidence of elevated albuminuria. Higher systolic blood pressure and baseline serum uric acid, and lower indices of b-cell function (C-peptide index and oral disposition index [oDI]), increased the risk of microal-buminuria, while higher triglycerides increased risk of micro-and macroalbumi-nuria. Lower oDI levels, female sex, and Hispanic ethnicity were associated with higher risk of hyperfiltration. CONCLUSIONS Elevated HbA1c was a shared risk factor among all phenotypes of DKD in this longitudinal cohort of adolescents and young adults with youth-onset type 2 diabe-tes. Other risk factors included elevated blood pressure, triglycerides, serum uric acid, and b-cell dysfunction.

Original languageEnglish (US)
Pages (from-to)1056-1064
Number of pages9
JournalDiabetes care
Volume45
Issue number5
DOIs
StatePublished - May 2022

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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