Effect of Puberty on Markers of Glomerular Hypertrophy and Hypertension in IDDM

Lawson, Margaret L.; Sochett, Etienne; Chait, Peter; Balfe, J. Williamson; Daneman, Denis

doi:10.2337/diab.45.1.51

Cited by 71 publications

(56 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…proliferative retinopathy [3]. Diabetic end-organ complications rarely occur before puberty, and the onset of puberty accelerates microvascular complications [4][5][6][7]. These observations suggest an association between sex hormones and diabetic end-organ complications.…”

Section: Introductionmentioning

confidence: 78%

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

2015

View full text Add to dashboard Cite

Aims/hypothesis The aim of this study was to evaluate the relationship among age at onset of diabetes, age at onset of menarche and risk of diabetic nephropathy and laser-treated retinopathy in type 1 diabetes. Methods Data related to age at menarche were collected through questionnaires and were available for 1,304 women who participated in the Finnish Diabetic Nephropathy Study (FinnDiane). A possible association between age at menarche and diabetic nephropathy and retinopathy was investigated. Results There was an inverse relationship between the age at onset of diabetes and age at menarche: the younger the age at onset of diabetes, the higher the age at menarche (p<0.0001). A non-linear relationship between the age of menarche and risk of diabetic microvascular complications was found in patients with diabetes onset before menarche, but there was no such association in patients with diabetes onset after menarche. Women with delayed menarche (> mean age+2 years) had a 2.30 (95% CI 1.27, 4.17; p<0.006) times higher risk of nephropathy compared with the women who underwent menarche at the mean age±2 years. Delayed menarche also increased the risk of retinopathy (OR 2.34 [95% CI 1.36, 4.01]). After excluding patients with nephropathy, the OR for retinopathy was 2.11 (95% CI 1.15, 3.90). Earlier menarche (< mean age−2 years) did not have any effect on this risk. Conclusions/interpretation Delayed menarche was associated with an increased risk of diabetic nephropathy and retinopathy, whereas early menarche was not. Delayed menarche may be used as a new tool to identify women at risk of diabetic microvascular complications.

show abstract

Section: Introductionmentioning

confidence: 78%

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

2015

View full text Add to dashboard Cite

show abstract

“…A cross-sectional study of 177 adolescents with type 1 diabetes showed that renal enlargement is associated with microalbuminuria as well as with pubertal duration [50]. Participants with kidney volume >300 ml/1.73 m 2 were eight times more likely to have microalbuminuria than those with kidney volume <300 ml/1.73 m 2 .…”

Section: Hyperfiltration and Nephromegalymentioning

confidence: 99%

The clinical significance of hyperfiltration in diabetes

et al. 2010

View full text Add to dashboard Cite

Glomerular filtration rate is commonly elevated in early diabetes and patients with this symptom are arbitrarily considered to have hyperfiltration. The prevalence of hyperfiltration in type 1 diabetes varies from less than 25% to more than 75%. The corresponding figures in type 2 diabetes are significantly lower, ranging between 0% and more than 40%. Several factors, methodological and biological, may contribute to the wide variation in estimates of hyperfiltration prevalence. Methodological differences in measurement and evaluation of GFR apply in particular to the handling of plasma disappearance curves of filtration markers. Biological factors that may influence GFR in the hyperfiltration range include glycaemic control, diabetes duration, BMI, sex, pubertal status in type 1 diabetes and age in type 2 diabetes. Hyperglycaemia may influence GFR and albuminuria, and may therefore confound the evaluation of hyperfiltration as an independent risk factor for diabetic nephropathy. Adequate assessment of the relationship between glycaemic control, GFR and AER therefore requires serial measurements of all three variables followed by multivariate analysis. A recent meta-analysis of ten type 1 diabetes studies concluded that the presence of hyperfiltration at baseline more than doubled the risk of developing micro-or macroalbuminuria at follow-up. However, not all studies allowed for confounding factors or regression dilution bias. Future studies will therefore need to address the independent role of hyperfiltration, not only in the evolution of albuminuria, but also in the subsequent decline of GFR.

show abstract

“…Em relação à terapêutica, a dose diária de insulina foi semelhante à observada em outras séries (9,25,26). Apesar da dose não ter diferença significativa entre os pacientes nos diferentes estágios de Tanner que pode ser justificado pelo tamanho da amostra, observamos uma tendência ao uso de maiores doses durante a puberdade, confirmando dados de literatura (27).…”

Section: Discussionunclassified

“…No nosso meio a grande miscigenação racial não nos permitiu categorizar os pacientes dificultando uma análise comparativa. Na análise estratificada em pré-púberes, púberes e adultos os níveis de HbA 1C não foram associados ao sexo em pré-púberes e adultos, semelhante a outros relatos da literatura (19,26). Como descrito em estudo multicêntrico europeu (27), os maiores níveis de HbA 1C foram observados em púberes do sexo feminino, diferente do relatado em uma série da Bélgica (25).…”

Section: Discussionunclassified

“…Como descrito em estudo multicêntrico europeu (27), os maiores níveis de HbA 1C foram observados em púberes do sexo feminino, diferente do relatado em uma série da Bélgica (25). Este fato pode ser devido ao maior IMC observado nestas pacientes o que é também discutido na literatura (25)(26)(27). Possivelmente outras variáveis bioquímicas e/ou clínicas não analisadas no presente trabalho influenciariam direta ou indiretamente o controle glicêmico das pacientes do sexo feminino durante a puberdade.…”

Section: Discussionunclassified

See 1 more Smart Citation

Inter-relação de variáveis demográficas, terapêutica insulínica e controle glicêmico em pacientes com diabetes mellitus do tipo 1 atendidos em um hospital universitário

Júnior

Fuks

Cunha

et al. 1999

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

RESUMOCom o objetivo de avaliar a inter-relação das variáveis demográficas, terapêutica insulínica e controle glicêmico no diabetes do tipo 1 (DM1), foram estudados 86 pacientes (44 F / 42 M), de 21,8±10 anos, 10 (11,6%) pré-púberes, 22 (25,6%) púberes e 54 (62,8%) adultos, com duração do DM de 8,6±7,1 ano e idade do diagnóstico de 13,2±8,5 anos, acompanhados durante o ano de 1997. O número de consultas anuais foi de 3,6±2,2, sem associação com sexo, raça e estágio de Tanner. A dose de insulina total foi de 0,9±0,4 U/kg/dia sendo que 72 deles (83,7%) utilizavam duas injeções por dia; 39 (45,3%) utilizavam insulina de ação rá-pida dos quais 36 (92,3%) em combinação com insulina de ação intermediária matinal. Na análise de regressão múltipla apenas a HbA 1C influenciou a dose de insulina (r=0,45; r 2 =0,21; p<0,001). A HbA 1C foi de 8,4±1,9%, sendo os maiores níveis observados no estágio 4, em comparação aos estágios 1, 2, 3 e 5 de Tanner, respectivamente (10,5±2,4 vs 7,6±1,4 vs 8,9±2,1 vs vs 8,3±2,4 vs 8,2±1,8%; p= 0,02). As adolescentes apresentaram maior HbA 1C e IMC que os adolescentes: 10,5±2,5 vs 8,3±2,0% (p= 0,02) e 19,4±1,9 vs 18,3±2,2 kg/m 2 (p= 0,04), respectivamente. O controle glicêmico foi considerado bom em 50% e péssimo em 31,4% dos pacientes. Concluímos que na amostra estudada houve uma piora do controle glicêmico no estágio final da puberdade, independente do número de consultas e das variáveis demográficas analisadas, e que o elevado número de pacientes com controle péssimo deverá nortear mudanças das estratégias terapêuticas. ABSTRACTTo evaluate the relationship between demographic variables, insulin therapy and glycemic control in type 1 diabetes mellitus (DM1), we studied 86 patients (44 F/ 42 M), aged 21.7±10 years: 10 (l 1.6%) prepubertal, 22 (25.6%) pubertal and 54 (62.8%) adults, with DM duration of 8.6+7.1 y and age at diagnosis of 13.2±8.5y. The number of clinic visits was 3.6±2.2 per year, with no association with gender, race and Tanner stage. Total insulin dose was 0.9±0.4 U/kg/day: 72 (83.7%) of the patients were using two daily injections; 39 (45.3%) were on fastacting insulin with 36 (92.3%) of them combined with a morning dose of intermediate-acting insulin. Multiple regression analysis showed that only HbA 1C had influenced the insulin dose (r=0.45; r 2 =0.21; p<0.001). HbA 1C was 8.4±1.9%, with higher leveis in stage 4 as compared to stages 1, 2, 3 and 5, respectively (10.5±2.4 vs 7.6±1.4 vs 8.9±2.1 vs. 8.3±2.4 vs 8.2±1.8%; p= 0.02). Pubertal females had higher HbA lc and BMI than males: 10.5±2.5 vs 8.3±2.0%; p= 0.02) and 19.4±1.9 vs 18.3±2.2 kg/m 2 (p= 0.04), respectively. Glycemic control was considered good in 43 (50%) and poor in 27 (31.4%) patients. In conclusion, glycemic control in this study sample had worsened at the end of puberty, independent of the number of clinic visits and of all demographic variables analysed.The high number of patients with poor control must also be considered. (Arq Bras Endocrinol Metab 1999;43/2:

show abstract

Effect of Puberty on Markers of Glomerular Hypertrophy and Hypertension in IDDM

Cited by 71 publications

References 38 publications

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

The clinical significance of hyperfiltration in diabetes

Inter-relação de variáveis demográficas, terapêutica insulínica e controle glicêmico em pacientes com diabetes mellitus do tipo 1 atendidos em um hospital universitário

Contact Info

Product

Resources

About