Prevalence and predictors of microalbuminuria and autoimmune comorbidities in children and adolescents with type 1 diabetes mellitus in Saudi Arabia: A retrospective cohort study

Type 1 diabetes mellitus (T1DM) in children is associated with long-term microvascular complications, including diabetic nephropathy, often presenting as microalbuminuria (MA). In parallel, autoimmune comorbidities are prevalent due to shared immunogenetic mechanisms. However, regional data on the co-prevalence of MA and autoimmune disorders in the Saudi pediatric population are limited. The present study aims to determine the prevalence and predictors of microalbuminuria and autoimmune comorbidities in children and adolescents with T1DM in Saudi Arabia. A retrospective cohort study was conducted at King Abdulaziz Medical City, Jeddah, involving 595 pediatric patients with T1DM. Data extracted included demographics, diabetes characteristics, and duodenal biopsy outcomes. Descriptive and multivariate analyses were conducted. Microalbuminuria was present in 8.9% of patients. HbA1c was significantly higher in patients with MA (mean 9.8% vs. 8.9%, p = 0.005), and diabetes duration was longer (8.6 vs. 6.8 years, p = 0.046). Height was also greater in the MA group (p = 0.024), possibly reflecting pubertal effects. Logistic regression identified HbA1c (OR 1.38, p = 0.005), duration (OR 1.15, p = 0.004), and height (OR 1.03, p = 0.047) as independent predictors of MA. Hashimoto thyroiditis was diagnosed in 9.5%, and significantly associated with MA (17.4% vs. 8.2%, p = 0.01). Celiac antibodies were positive in 5.4%, but only a portion had biopsy-confirmed disease. Microalbuminuria affects nearly 1 in 11 Saudi children with T1DM and is strongly associated with poor glycemic control and longer disease duration, emphasizing the need for integrated endocrine and renal monitoring in pediatric diabetes care.