ESPN 51th Annual Meeting

ESPN 2018


 
Factors influencing blood pressure in children with diabetes mellitus type 1: Salt or Sugar?
SEHA SAYGILI 1 NUR CANPOLAT 1 AYDİLEK ÇAKIR 2 DİLDAR KONUKOĞLU 3 SALİM ÇALIŞKAN 1 HANDE TURAN 2 OYA ERCAN 2 OLCAY EVLİYAOĞLU 2 LALE SEVER 1

1- DEPARTMENT OF PEDIATRICS, DIVISION OF PEDIATRIC NEPHROLOGY, İSTANBUL UNIVERSITY CERRAHPAŞA FACULTY OF MEDICINE, İSTANBUL, TURKEY.
2- DEPARTMENT OF PEDIATRICS, DIVISION OF PEDIATRIC ENDOCRINOLOGY, İSTANBUL UNIVERSITY CERRAHPAŞA FACULTY OF MEDICINE, İSTANBUL, TURKEY.
3- DEPARTMENT OF BIOCHEMISTRY, İSTANBUL UNIVERSITY CERRAHPAŞA FACULTY OF MEDICINE, İSTANBUL, TURKEY.
 
Introduction:

Hypertension is a major risk factor for cardiovascular disease in patients with diabetes mellitus type 1. There are several adult studies on effects of dietary salt intake on blood pressure and microalbuminuria in patients with diabetes mellitus (DM). We aimed to investigate the effect of both salt intake and the factors associated with diabetes itself on blood pressure. 

Material and methods:

 This cross-sectional single center study included 94 patients with type-1 DM aged between 7-21 years(patient group) and age- and sex-matched 61 healthy children(control group). 24-hour urinary Na excretion(mmol/L) was measured, and daily salt excretion(g/day) was calculated. Microalbuminuria, angiotensinogen and 8-OHdG as early markers for diabetic nephropathy were measured in 24 hours urine specimens in both groups. Blood pressures were evaluated by using ambulatory blood pressure monitoring (ABPM) in the patient group. Patients with 24-hour MAP-SDS ≥95th percentile were diagnosed as hypertensive. 

Results:

The mean age at the onset of disease and disease duration were 6.9±3.4 and 7.1±3.1 years, respectively. The average level of HbA1c in the last year was 8.9±1.4g/dL. There was no difference in urinary salt excretion between the patient and control groups (19.8±8.4 vs 17.6±8.2g/day, p=0.10). Early markers did not differ between the two groups, except urinary level of microalbumin, which was higher in the patient group (p=0.041). Microalbuminuria (>30mg/day) was found in 12 patients. The median (IQR) 24-h MAP-SDS was -0.13 (-0.7; 0.52), and 7 patients (7.4%) had hypertension. A high 24-h MAP-SDS was independently associated with higher levels of urinary microalbumin [95%CI:0.002-0.009; p=0.001] and HbA1c [95%CI:0.091-0.366;p=0.001] and higher BMI-SDS [95%CI: 0.099 to 0.467,p=0.003], but not with daily salt excretion, angiotensinogen or 8-OHdG.

Conclusions:

Our findings reveal that poor glycemic control appears to be the most important risk factor for hypertension in children with type-1 diabetes mellitus. In this cohort with high amount of salt consumption above daily recommendations, we did not find any association of salt intake with blood pressure.