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

1. Pacific Islander and native 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 has not been associated with hypertension and albuminuria in pediatric patients with type 2 diabetes.

Level of evidence assessment: 1 (Excellent)

Study Rundown: Diabetes-related nephropathy is a common consequence of type 2 diabetes, resulting in chronic kidney disease and progressive loss of kidney function. Diabetes-related nephropathy can be screened by detecting high blood pressure (BP) and high levels of albumin in a person’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 whether diabetes-related nephropathy symptoms can be screened in pediatric populations. The study also examined whether hypertension and albuminuria were correlated with the race / ethnicity of the patients, as well as with obesity status. The analysis of hypertensive studies included 46 studies with a total population of 4363 pediatric patients with type 2 diabetes. Of this population, 25.33% of patients were considered hypertensive. Pacific Islander youth were also known for having the highest prevalence of hypertension when compared to other ethnic groups. Male participants had a higher risk of hypertension in 4 studies, while female participants had a higher risk of hypertension in 1 study in which hypertension was considered a systolic or diastolic blood pressure in the 98th percentile. Metaregression analysis also showed that obesity was not associated with hypertension, although obesity status was not available for all studies. Albuminuria was common in 22.17% of patients in 14 studies for a total population of 2,250 participants. Pacific Islander and indigenous youth had a higher risk of albuminuria and no association with obesity and participant sex was established. These findings suggest that signs of diabetes-related nephropathy can be detected in pediatric patients. A major limitation of this review was that there were no strict exclusion criteria or definitions for hypertension and albuminuria, and studies were used that varied in reported data.

Click to read the study in JAMA Network Open

Relevant literature: rapid rise in hypertension and nephropathy in adolescents with type 2 diabetes

Profound [systematic review and meta-analysis]: This systematic review was performed to determine the prevalence of hypertension or albuminuria in pediatric patients with type 2 diabetes and to determine whether race / ethnicity, gender, or obesity status is correlated with hypertension and / or albuminuria. The review included 60 studies from a search of 7,614 observational studies around the world. From these 60 studies, study design, sample size, age of the patient at diabetes diagnosis, age of the patient at enrollment, duration of diabetes, gender, and race were collected. Definitions of hypertension and albuminuria used, and the hypertension, albuminuria and obesity status of patients closest to the time of diabetes diagnosis were collected. To be included in the review, the studies had to have the majority of patients under the age of 18. The results of the review were categorized based on what the original study used as their definition of hypertension and albuminuria. When analyzing the prevalence of hypertension, 46 studies had data on the patient’s hypertension status. 31 studies out of these 46 categorized a participant with hypertension if they had systolic blood pressure in the 95th percentile or with systolic blood pressure of 130-140 mmHg or diastolic blood pressure of 80-90 mmHg. The remaining studies included having a systolic blood pressure of 130-140 mmHg alone, or a diastolic blood pressure of 80-90 mmHg alone, or the 85th percentile for systolic blood pressure, or the 85th percentile for diastolic blood pressure. Across all studies, Pacific Islander adolescents 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%]. Men also had a higher risk of hypertension, except in 1 study, which required a participant to have a BP in the 98th percentile. The prevalence of albuminuria was slightly lower at a rate of 22.17% [95% CI 17.34%-27.38%] and even lower if all participants over 18 years old are removed 17.00% [95%CI 9.00%-27.00%]. The same ethnic trend continued when reviewing the prevalence of albuminuria, with Pacific Islander youth having the highest risk of albuminuria with a 31.84% risk [CI, 11.90%-55.47%] and indigenous youth with the second highest risk of 24.27% [CI, 14.39%-35.73%]. Both hypertension and albuminuria were not associated with obesity in this review, but are believed to be due to a lack of data.

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