关键词: 1型糖尿病, 糖尿病肾病, 尿白蛋白比肌酐比值, 胰岛素抵抗

Abstract: Objective Diabetic kidney disease (DKD) is closely related to end-stage renal failure and increased risk of cardiovascular disease in type 1 diabetes mellitus (T1DM). To investigate factors associated with urinary albumin-to-creatinine ratio (UACR) and establish the prediction model for elevation of UACR among adults with T1DM. Methods Eligible adults with T1DM from Guangdong Type 1 Diabetes Translational Study who were enrolled between January, 2016 and December, 2017. Basic characteristics and clinical information were collected. All patients were divided into two groups: normal UACR group (UACR < 30 mg/g) and elevated UACR group (UACR ≥ 30 mg/g) according to their UACR level. To screen factors that were potentially associated with UACR, comparison of clinical variables between the two groups were performed. Logistic regression analysis and Nomogram model were used to explore major factors associated with UACR and to predict the probability of UACR elevation. Results A total of 495 patients were enrolled, with a mean age of (34.44±11.65) years and diabetes duration of (7.83±6.22) years. Among them, 296 patients (59.8%) were women. 385 patients (77.8%) were assigned to the normal UACR group and 110 patients (22.2%) to the elevated UACR group. Findings from the comparisons between the two groups demonstrated that diabetes duration, systolic blood pressure(SBP), diastolic blood pressure(DBP), resting heart rate, glycosylated hemoglobin A1c(HbA1c), estimated glucose disposal rate (lneGDR), hypertension were associated with UACR. The results of logistic regression showed that lneGDR [OR=0.33 (95%CI，0.17～0.60), P＜0.05] was a protective factor from UACR elevation, while resting heart rate [OR=1.03 (95% CI, 1.00～1.05), P＜0.05] and presence of hypertension [OR=2.17 (95% CI, 1.29～3.63), P＜0.05] were risk factors. The Nomogram model suggested that a higher probability of UACR elevation was associated with lower lneGDR (i.e., greater insulin resistance), higher resting heart rate, longer diabetes duration and the presence of hypertension. Conclusion Many factors were associated with UACR among adult T1DM patients in China. It is possible to reduce the incidence of UACR by improving insulin resistance, controlling resting heart rate and blood pressure, so as to provide ideas for the prevention and control of DKD among adults with type 1 diabetes mellitus.

Key words: type 1 diabetes mellitus, diabetic kidney disease, urinary albumin-to-creatinine ratio, insulin resistance