期刊
DIABETES CARE
卷 36, 期 6, 页码 1735-1741出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc12-2420
关键词
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资金
- NIDDK/National Institutes of Health (NIH) [U01-DK-61212, U01-DK-61230, U01-DK-61239, U01-DK61242, U01-DK-61254]
- National Center for Research Resources General Clinical Research Centers Program (Washington University School of Medicine) [M01-RR-00036]
- National Center for Research Resources General Clinical Research Centers Program (Children's Hospital Los Angeles) [M01-RR-00043-45]
- National Center for Research Resources General Clinical Research Centers Program (University of Colorado Denver) [M01-RR-00069, UL1-RR-025780]
- National Center for Research Resources General Clinical Research Centers Program (Children's Hospital of Pittsburgh) [M01-RR-00084, UL1-RR024153]
- National Center for Research Resources General Clinical Research Centers Program (Massachusetts General Hospital) [M01-RR-01066, UL1-RR-025758]
- National Center for Research Resources General Clinical Research Centers Program (Yale University) [M01-RR-00125, UL1-RR-024139]
- National Center for Research Resources General Clinical Research Centers Program (University of Oklahoma Health Sciences Center) [M01-RR-14467]
- National Center for Research Resources Clinical and Translational Science Award (Children's Hospital of Philadelphia) [UL1-RR024134]
- National Center for Research Resources Clinical and Translational Science Award (Case Western Reserve University) [UL1 RR-024989]
- National Center for Research Resources Clinical and Translational Science Award (Washington University in St. Louis) [UL1-RR-024992]
OBJECTIVE-Among adolescents with type 2 diabetes, there is limited information regarding incidence and progression of hypertension and micro-albuminuria. Hypertension and microalbuminuria assessments made during the TODAY clinical trial were analyzed for effect of treatment, glycemic control, sex, and race/ethnicity. RESEARCH DESIGN AND METHODS-A cohort of 699 adolescents, 10-17 years of age, <2 years duration of type 2 diabetes, BMI >= 85% HbA(1c) <= 8% on metformin therapy, controlled blood pressure (BP), and calculated creatinine clearance >70 mL/min, were randomized to metfot min, metformin plus rosiglitazone, or metformin plus intensive lifestyle intervention. Primary study outcome was loss of glycemic control for 6 months or sustained metabolic decompensation requiring insulin. Hypertension and microalbuminuria were managed aggressively with standardized therapy to maintain BP <130/80 or <95th percentile for age, sex, and height and microalbuminuria <30 mu g/mg. RESULTS-In this cohort, 319 (45.6%) reached primary study outcome, and 11.6% were hypertensive at baseline and 33.8% by end of study (average follow-up 3.9 years). Male sex and higher BMI significantly increased the risk for hypertension. Microalbuminuria was found in 6.3% at baseline and rose to 16.6% by end of study. Diagnosis of microalbuminuria was not significantly different between treatment arms, sex, or race/ethnicity, but higher levels of HbA(1c) were significantly related to risk of developing microalbuminuria. CONCLUSIONS-Prevalence of hypertension and microalbuminuria increased over time among adolescents with type 2 diabetes regardless of diabetes treatment. The greatest risk for hypertension was male sex and higher BMI. The risk for microalbuminuria was more closely related to glycemic control.
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