Prevalence of Hypertension and Albuminuria in Pediatric Type 2 Diabetes

Abstract

IMPORTANCE Hypertension and albuminuria are markers of diabetes-related nephropathy and important factors associated with kidney outcomes in pediatric type 2 diabetes. However, their prevalence in these patients is unknown. OBJECTIVE To measure the prevalence of hypertension and albuminuria in pediatric patients with type 2 diabetes and to evaluate the association of sex and race/ethnicity with these conditions. DATA SOURCES MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, the gray literature, and references of the screened articles were searched for human studies from date of database inception to February 20, 2020. STUDY SELECTIONObservational studies with at least 10 participants reporting the prevalence of hypertension and/or albuminuria in pediatric patients with type 2 diabetes were included. Three teams of 2 independent reviewers screened 7614 papers, of which 60 fulfilled the eligibility criteria.DATA EXTRACTION AND SYNTHESIS Three teams of 2 independent reviewers performed data extraction, risk of bias analysis, and level of evidence analyses. The meta-analysis was conducted using a random-effects model and followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. MAIN OUTCOMES AND MEASURESThe primary outcomes included the pooled prevalence rates (percentages with 95% CI) for hypertension and albuminuria. The secondary outcomes assessed pooled prevalence rates by sex and racial/ethnic group. RESULTSSixty studies were included in the systematic review. Diabetes duration varied from inclusion at diagnosis to 15.0 years after diagnosis, and the reported mean age at diagnosis ranged from 6.5 to 21.0 years. Hypertension prevalence among 3463 participants was 25.33% (95% CI, 19.57%-31.53%). Male participants had higher hypertension risk than female participants (odds ratio [OR], 1.42 [95% CI, 1.10-1.83]), with Pacific Islander and Indigenous youth having the highest prevalence of all racial/ethnic groups (Pacific Islander youth: 26.71% [95% CI, 14.54%-40.72%];

Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

“…Evidence indicates, however, that renal involvement in youth onset T2DM occurs early in the disease course, and that progression is similar to that seen in adult T2DM onset [26]. Early manifestation of T2DM renal complication is represented by microalbuminuria, the most commonly reported complication in children and adolescents with T2DM [27]. Estimates vary widely between 7 and 22% at presentation, and between 9.6 and 72% within 3-10 years after diagnosis [25].…”

Diabetic kidney disease in pediatric patients: A current review

“…Another important sign of diabetes-related nephropathy is BP measurement. In pediatric T2DM the guidelines recommend BP and UACR evaluation at diagnosis and annually thereafter[ 58 ].…”

“…Teenagers with T1DM are at risk for hyperfiltration and higher UACR (urinary albumin-to-creatinine ratio), which are biomarkers for early/ incipient nephropathy[ 35 ]. A recent meta-analysis found that almost 25% of T2DM patients have arterial hypertension, the male sex being more frequently affected, and that 1 in 4 or 5 children have albuminuria[ 58 ].…”

Pharmacotherapy in paediatric type 2 diabetes mellitus: a protocol for a systematic review and network meta-analysis of randomised trials

“…[9][10][11] At presentation and within the first few years postdiagnosis, patients may develop hypertension, proteinuria, dyslipidaemia, obstructive sleep apnoea, non-alcoholic fatty liver disease and polycystic ovary syndrome. [12][13][14][15] Patients are also predisposed to retinopathy and neuropathy that occur more frequently and earlier in T2DM patients when compared with their T1DM counterparts. 16 There is significant evidence demonstrating that tight glycaemic control improves diabetes…”

“…Paediatric T2DM is associated with comorbidities and complications that arise early in the course of the disease 9–11. At presentation and within the first few years postdiagnosis, patients may develop hypertension, proteinuria, dyslipidaemia, obstructive sleep apnoea, non-alcoholic fatty liver disease and polycystic ovary syndrome 12–15. Patients are also predisposed to retinopathy and neuropathy that occur more frequently and earlier in T2DM patients when compared with their T1DM counterparts 16…”