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AdDIT: Test identified youth with diabetes at greatest CVD risk
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Adolescents with type 1 diabetes who have elevated but within normal levels of albumin are at increased risk for arterial stiffening, atypical lipid profiles and hyperfiltration compared with patients who have low or moderate levels. However, urinary screening can identify these high-risk patients, according to data from an ongoing trial.
The preliminary results of the Adolescent Type 1 Diabetes Cardio-Renal intervention Trial (AdDIT) are consistent with data from adults with type 1 diabetes. However, the mechanism linking renal and cardiovascular disease to type 1 diabetes remains unclear, according to David B. Dunger, MD, of the department of pediatrics at the University of Cambridge, United Kingdom, and colleagues.
“Managing type 1 diabetes is difficult enough without having to deal with other health problems. By using early screening, we can now identify young people at risk of heart and kidney disease,” Dunger said in a press release. “The next step will be to see if drugs used to treat heart and kidney disease — such as statins and blood pressure lowering drugs — can help prevent kidney and heart complications in this young, potentially vulnerable population.”
Adolescents aged 10 to 16 years (n=3,353) were included in the preliminary screening for AdDIT. Researchers measured their albumin-to-creatinine ratio (ACR) via two sets of three consecutive early morning urine samples and assigned patients to calculated tertiles based on risk assessments.
There were 959 (28.6%) patients assigned to the lower tertile, 1,112 (33.2%) to the middle tertile and 1,282 (38.2%) patients assigned to the upper tertile of ACR, according to data.
Of those with the highest risk (upper tertile), 400 patients were included in the interventional trial cohort. Of those with a lower risk (middle-lower ACR tertiles), 329 were included in the observational cohort, researchers wrote.
Vascular measurements of age- and sex-adjusted pulse wave velocity were greater among patients in the trial compared with the observational cohort (5 m/s vs. 4.86 m/s; P=.021). Non-HDL cholesterol (2.95 mmol/L vs. 2.81 mmol/L; P=.02) and apolipoprotein B-to-ApoA-I ratio (0.5 vs. 0.47; P=.04) also were higher among patients in the trial cohort, according to data.
However, cystatin C (0.88 ng/mL vs. 0.9 ng/mL; P=.04) and creatinine (51.81 mmol/L vs. 55.35 mmol/L; P<.001) levels were lower in the trial cohort compared with the observational cohort; estimated glomerular filtration rate levels (137.05 mL/min/1.73m2 vs. 129.31 mL/min/1.73m2; P<.001) were higher in the trial cohort compared with the observational cohort.
“Our results on cystatin C and eGFR are consistent with previous observations that hyperfiltration is frequent among adolescents with type 1 diabetes who later go on to develop microalbuminuria,” the researchers wrote.
Therefore, researchers recommend early screening to identify adolescents at risk for comorbidities associated with diabetes.
Disclosure: The researchers report no relevant financial disclosures.
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