The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

Abstract

Aims/hypothesis We determined the longitudinal relationship between adiponectin levels and the development of microalbuminuria in an inception cohort of children with type 1 diabetes. Methods Blood samples collected annually over a median of 9.0 (range 1.3-14.9) years were assayed for adiponectin and HbA 1c in 55 children (36 girls) with type 1 diabetes and microalbuminuria whose age of onset of diabetes was 9.4 years (range 2.2-15.4). Samples were also assayed from normoalbuminuric children (controls) matched for age, sex and duration of diabetes. Results Overall, adiponectin levels were higher in girls than in boys, but only after 11 years of age (median [range]: 15.3 [5.8-124.4] vs 11.6 [4.1-26.5] mg/l, p<0.001). Furthermore, adiponectin levels were higher in girls with microalbuminuria than in control girls, but this was only apparent after the onset of microalbuminuria (p=0.001, adjusted for BMI, daily insulin dose, HbA 1c and age). In boys, adiponectin levels did not differ between those with microalbuminuria and controls. Further sex-related discordant associations with adiponectin levels were observed; in girls, adiponectin levels were positively related to HbA 1c levels (r=0.2, p=0.05) and urine albumin excretion (r=0.3, p<0.05) and inversely related to BMI (r=−0.2, p<0.05). These associations were absent in boys. Conclusions/interpretation In adolescent girls with type 1 diabetes but not in boys, adiponectin levels increase with increasing urine albumin excretion and onset of microalbuminuria. Although causal links cannot be inferred, this sexual dimorphism may reflect interactive effects of hyperglycaemia and sex steroids on risk of complications and adiponectin production.

Longitudinal Analysis of Adiponectin through 20-Year Type 1 Diabetes Duration

“…Most studies of adiponectin in type 1 diabetes have been cross-sectional and clinic based [ 4 , 8 , 18 – 20 ], and few included multicenter or population-based samples [ 9 , 10 , 12 – 14 ]. Limited longitudinal investigations have primarily followed younger individuals [ 7 , 21 , 22 ], and none have spanned durations from diagnosis during childhood through long-standing diabetes in adults. Consequently, there is little information on how adiponectin changes across longer type 1 diabetes duration and whether factors associated with adiponectin levels differ during early and later diabetes.…”

Urinary adiponectin concentration is positively associated with micro- and macro-vascular complications

“…Several earlier studies focused on the relationship between plasma adiponectin and renal complications in diabetic patients [6,16]. Few researchers, however, have investigated the association between urinary adiponectin level and vascular damage.…”

“…A relationship between circulating adiponectin level and metabolic conditions such as insulin resistance, obesity, and diabetes mellitus has been demonstrated in previous studies [2-4]. Circulating adiponectin concentration has been shown to be significantly correlated with microalbuminuria and overt nephropathy in type 1 diabetic patients [5,6]. Furthermore, some researchers have reported an association between adiponectin concentration and vascular diseases or arterial stiffness using pulse wave velocity [7-9].…”

Association of the PGC-1αrs8192678 Variant with Microalbuminuria in Subjects with Type 2 Diabetes Mellitus

“…All subjects had diabetes according to WHO criteria [27]. Microalbuminuria was defined as an albumin:creatinine ratio (ACR) of greater than 2.5 mg/mmol in men and 3.5 mg/mmol in women [28][29][30]. Macroalbuminuria was defined as an ACR > 30 mg/mmol.…”