Findings of global type 1 teenager study unveiled
A landmark study involving thousands of teenagers with type 1 diabetes has shown ACE inhibitors or statins do not significantly reduce the levels of albumin in the urine.
The four-year trial, entitled Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT), was developed to understand more about the development of long-term complications in young people with the condition.
It is well known that controlling levels of glucose in the blood can help to reduce the risk of complications for people with diabetes, but this can be particularly difficult to achieve during adolescence. Future heart and kidney problems can reduce life expectancy by 10-15 years.
So the global research team from the UK, Canada and Australia set about studying the risk of complications during puberty and whether ACE inhibitors and statins could reduce the risk of kidney, eye and cardiovascular disease.
Professor David Dunger, lead researcher of the AdDIT trial in the UK, based at the University of Cambridge, said: “This has been an amazing international collaboration involving over 4,000 young people with type 1 diabetes and many collaborating physicians across three continents.
“Studies in adolescence are said to be challenging, but our young participants were fantastic, following a complex protocol and demonstrating that the interventional drugs were well tolerated for up to four years. The therapies reduced harmful lipid levels and the risk of progression to microalbuminuria, both thought to be predictors of future risk for renal, cardiovascular and retinal complications.
“There is no reason to believe that these findings will not translate into long-term benefits, but follow-up of this unique cohort will be essential. The essential biological samples and data provided by the participants, overall totaling at more than 800 teenagers, will continue to inform our future understanding and our options for effective therapies for this vulnerable group of young people with type 1 diabetes.”
Although the primary outcome of the trial was negative, the secondary outcomes suggested the drugs may have important benefits. The team found that treatment with the ACE inhibitor resulted in a 43 per cent reduction in the rates of progression to microalbuminuria.
While this did not reach statistical significance, the team believe it may be of clinical relevance in the future. Preventing even temporary cases of microalbuminuria is known to reduce the future risk of kidney and cardiovascular complications.
The research has been published in the New England Journal of Medicine and it was supported by JDRF, the British Heart Foundation and Diabetes UK.
Future work is still needed to establish the full benefits of statins and ACE inhibitors in young people with type 1 diabetes. The research team has suggested that the impact of ACE inhibitor or statin treatment may be felt later, as seen in other glucose-, lipid-, or blood pressure-lowering trials. They hope to follow participants for a further five to 10 years, to determine the long-term effects of the treatments.
Dr Elizabeth Robertson, director of research at Diabetes UK, said: “We need to find ways to reduce the risk of complications for young people with type 1 diabetes. The AdDIT study has achieved excellent engagement amongst young people across three continents. While more work is needed to reach definitive answers, we’d like to take this moment to celebrate with everyone who has supported this research. Thank you for your dedication.”]
To read the research, click here.