Factors Related to the Development of Microalbuminuria in Children and Adolescents with Type 1 Diabetes Mellitus

PURPOSE: We observed the prevalence rate of microalbuminuria(MA) and its relationship with the various clinical factors in children and adolescents with type 1 diabetes mellitus(DM). METHODS: Seventy two children and adolescents(26 males and 46 females, 17.1+/-3.0 years) were included. MA was defined as 24 hour urine microalbumin >30mg/day(20microgram/min). Subjects were classified into three groups(normoalbuminuria, transient MA, or persistent MA). Additionally, sub jects were classified into another three groups according to age at diagnosis(11 years), arbitrarily. Clinical characteristics were analyzed between these groups and prevalence rates of MA by age and by duration of diabetes were analyzed. RESULTS: Of the 72 patients, 42(58.3%), 11(15.3%), and 19(26.4%) patients were included in nor moalbuminuric, transient MA, and persistent MA group, respectively. The mean level of HbA1c in persistent MA group was greater than those of other groups(P<0.01). The prevalence rates of diabetic retinopathy(27.8%) and neuropathy(16.7%) in the persistent MA group were higher than those in other groups(P<0.05). The cumulative incidence for developing persistent MA was 1.4% at 13 years, 4.7% at 15 years, and 20.7% at 18 years of age. The cumulative incidence for developing persistent MA was 3.4% after 6 years, 15.6% after 7 years, and 17.8% after 8 years. In patients who were diagnosed before 11 years of age, the appearance of persistent MA was delayed until pubertal age, whereas those who were diagnosed after 11 years of age developed persistent MA earlier after diagnosis. CONCLUSION: These data suggest that screening for MA should be performed in children and adolescents who have had diabetes for more than 5 years, or have entered into puberty, especially those with poor metabolic control.

The Impact of Prolonged Breast Milk Feeding and Large Amount of Whole Cow' s Milk Intake on Iron Status in Early Childhood

PURPOSE: The Large amounts of whole cow' s milk intake, just followed by prolonged breast milk feeding may induce a severe deficit of iron. We performed this study to investigate the severity of iron deficiency in these subjects. METHODS: Seventy-one subjects (12 to 48 months of age) were classified according to history of prolonged breast milk feeding and intake of large amounts of whole cow' s milk. Prolonged breast milk feeding and large amounts cow' s milk intake subjects were assigned as group A (n=15), the large amounts of cow's milk intake subjects as group B (n=15), the prolonged breast milk feeding subjects as group C (n=24) and the normal control subjects as Group D (n=17). The hematologic and iron status were evaluated and compared between each group. RESULTS: Although the mean of group A was lower than the mean of group B and C, the level of hemoglobin of group A was significantly lower than group D (P<0.01). The level of the ferritin of group A was significantly lower than group B, C (P<0.05, respectively) and group D (P<0.01). Of the 15 study subjects of group A, 14 (93.3%) had microcytic hypochromic anemia and 7 (46.7%) revealed that serum ferritin levels were at 1.0ng/dL, indicating severe deficit of storage iron. CONCLUSION: The intake of large amounts of whole cow' s milk, just followed by prolonged breast milk feeding induced iron deficiency anemia and a severe deficit of storage iron. It is necessary to inform parents to avoid irreversible recognition impairment and behavioral change.