Hypertension and albuminuria highly prevalent in pediatric patients with type 2 diabetes
Hypertension and albuminuria highly prevalent in pediatric patients with type 2 diabetes

1. Pacific Islander and Indigenous pediatric type 2 diabetes patients were found to have the higher rates of hypertension and albuminuria, compared to type 2 diabetic pediatric patients of other ethnicities.

2. Obesity was not associated with hypertension and albuminuria in pediatric patients with type 2 diabetes.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Diabetes-related nephropathy is a common result of type 2 diabetes which results in chronic kidney disease and progressive loss of kidney function. Diabetes-related nephropathy can be screened for by detecting high blood pressure (BP) and high levels of albumin in an individual’s urine. This systematic review analyzed 60 cohort and cross-sectional studies of type 2 diabetic pediatric patients to calculate the prevalence of hypertension and albuminuria in these patients, to evaluate if diabetes-related nephropathy signs can be screened for in pediatric populations. The study also investigated if hypertension and albuminuria was correlated to patients’ race/ethnicity, as well as obesity status. The analysis of hypertensive studies included 46 studies with a total population of 4363 type 2 diabetic pediatric patients. From this population, 25.33% of patients were considered hypertensive. Pacific Islander youth were also noted for having the highest prevalence of hypertension compared to any other ethnicity. Male participants had a higher risk of hypertension across 4 studies, while female participants had a higher risk of hypertension in 1 study which considered hypertension as having either systolic or diastolic BP in the 98th percentile. Metaregression analysis also showed obesity was not associated with hypertension, although obesity status was not available for all studies. Albuminuria was prevalent in 22.17% of patients across 14 studies for a total population of 2250 participants. Pacific Islander and Indigenous youth had a higher risk of albuminuria and no association with obesity and participant’s sex were detected. These findings suggest that signs of diabetes-related nephropathy can be detected in pediatric patients. A major limitation of this review was that it did not have a strict exclusion criteria or definitions for hypertension and albuminuria, along with using studies varying in reported data.

Click to read the study in JAMA Network Open

Relevant Reading: Rapid Rise in Hypertension and Nephropathy in Youth with Type 2 Diabetes

In-Depth [systematic review and meta-analysis]: This systematic review was done in order to determine the prevalence of hypertension or albuminuria in pediatric patients with type 2 diabetes, and to determine if race/ethnicity, sex, or obesity status is correlated to hypertension and/or albuminuria. The review included 60 studies from a search of 7614 observational studies around the world. From these 60 studies the study design, study sample size, patient age at diabetes diagnosis, patient age at enrollment, duration of diabetes, sex, and race were collected. Definitions of hypertension and albuminuria used, and patients’ hypertension, albuminuria, and obesity status were collected closest to the time of diabetes diagnosis. In order to be included in the review, studies needed to have most patients under the age of 18. The results from the review were categorized based upon what the original study used as their definition of hypertension and albuminuria. When analyzing hypertension prevalence, 46 studies had data on patient hypertension status. 31 studies from these 46 categorized a participant with hypertension if they had a systolic BP in the 95th percentile or with a systolic BP of 130-140 mmHg or a diastolic BP of 80-90 mmHg. Remaining studies included having a systolic BP 130-140 mmHg alone, or having a diastolic BP 80-90 mmHg alone, or being in the 85th percentile for systolic BP, or being in the 85th percentile for diastolic BP. Across all studies Pacific Islander youth had the highest prevalence of hypertension with a prevalence of 26.71% [95% CI, 14.54%-40.72%]. Indigenous youth also had a similarly high prevalence, with a rate of 26.48% [95% C1, 17.34%-36.74%]. Males also had a higher risk of hypertension except in 1 study, which required a participant to have a BP in the 98th percentile. Albuminuria prevalence rates were slightly lower with a rate of 22.17% [95% CI 17.34%-27.38%] and even lower if removing all participants older than 18 17.00% [95%CI 9.00%-27.00%]. The same ethnic trend continued while reviewing albuminuria prevalence, with Pacific Islander youth having the highest risk of albuminuria with a risk of 31.84% [CI, 11.90%-55.47%] and indigenous youth having the second highest risk of 24.27% [CI, 14.39%-35.73%]. Both hypertension and albuminuria did not show an association to obesity in this review, however that is believed to be due to a lack of data.

Image: PD

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