Association of low-grade albuminuria and triple-line pattern as markers of early peripheral vascular remodeling in adolescents with type 1 diabetes.

Abstract

Background: Adolescents with type 1 diabetes (T1D) face premature atherosclerosis, but standard carotid intima-media thickness (IMT) may lack sensitivity for the earliest vascular injuries. Since urinary albumin-to-creatinine ratio (UACR) reflects systemic endothelial dysfunction, we investigated the triple-line pattern (TLP) as a marker of peripheral remodeling and its dose-response relationship with low-grade albuminuria.

Methods: The Subclinical Cardiovascular Disease in Type 1 Diabetes Mellitus (SCVD T1DM) cohort study prospectively recruited 283 adolescents with T1D and 106 age- and sex-matched controls. IMT was measured at the common carotid artery and common femoral artery (CFA) using high-resolution ultrasound. Logistic regression tested categorical UACR thresholds, and restricted cubic spline models evaluated the continuous dose-response association between UACR and TLP.

Results: TLP prevalence was higher in type 1 diabetes than in controls (63.9% vs 49.1%, P = 0.008). While type 1 diabetes was associated with carotid thickening, TLP was linked to structural changes in the lower extremities. TLP-positive participants had greater mean CFA IMT (0.56 ± 0.06 vs 0.44 ± 0.06 mm, P < 0.001). UACR ≥15 mg/g independently predicted TLP (odds ratio 2.83, 95% confidence interval 1.01-7.92, P = 0.048), whereas UACR ≥30 mg/g was not significant. Spline analysis showed no significant nonlinearity (P for nonlinearity = 0.424), with risk increasing above approximately 15 mg/g.

Conclusions: TLP is a prevalent marker of incipient peripheral vascular remodeling in adolescents with type 1 diabetes without macroalbuminuria. A UACR ≥15 mg/g identifies subclinical vascular risk below conventional thresholds, supporting TLP as a potential tool for refined early risk stratification in this population.