Research helps identify young people with type 1 diabetes at risk of heart and kidney disease

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University of Cambridge
Research helps identify young people with type 1 diabetes at risk of heart and kidney disease Screening could enable early intervention Using a simple urine test, researchers can now identify young people with type 1 diabetes at risk of heart and kidney disease. The new research, funded by JDRF, Diabetes UK, and the British Heart Foundation (BHF), was published today, 06 November, in the journal Diabetes Care.

Up to 40 per cent of young people with type 1 diabetes may be at risk of kidney disease, a complication which also increases the risk of heart disease. In the first study of its kind, researchers examined the link between levels of albumin (a protein typically found in the blood but also excreted in small amounts in the urine) in the urine of adolescents with type 1 diabetes and the relative risk of heart and kidney diseases.

Although elevated albumin levels in the urine are already used to identify adults with diabetes who are at higher risk of kidney and heart disease, this is the first time that researchers have shown that normal variation in these levels can be an indicator of risk during adolescence.

Professor David Dunger, the lead author of the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) study from the University of Cambridge, said: "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. 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."

For the study, researchers from the UK, Canada and Australia measured albumin levels in the urine of 3,353 adolescents (10-16 years old) with type 1 diabetes as well as assessed the young people for early signs of heart and kidney disease such as stiffening of the arteries, abnormal lipid (blood fat) profiles and kidney function.

They found that adolescents with type 1 diabetes whose urinary albumin levels were in the top 30% – but still within what is currently considered the 'normal' range - showed more evidence of early kidney and cardiovascular complications than those with lower levels. Helen Nickerson, Scientific Program Manager at JDRF in New York, said: "We are grateful to the study team and all the trial participants for their efforts leading to this initial data. We hope the continued participation of subjects as the AdDIT trial progresses will reveal new information about kidney and heart risk in type 1 diabetes, as well as testing a possible way to reduce this risk." Dr Sanjay Thakrar, Research Advisor at the BHF, which helped to fund the study, said: "This exciting early finding shows that we could identify those young people with type 1 diabetes who are most at risk of developing coronary heart disease. The researchers now need to assess whether early treatment with standard heart medication could help to keep these young people's hearts healthy in the future."

Dr Alasdair Rankin, Director of Research for Diabetes UK, said: "Every year, too many people with type 1 diabetes experience kidney failure and heart disease as a result of their diabetes and this can have a really devastating effect on their lives. By showing that people at high risk of these complications can be identified when they are children, this research offers the exciting prospect that in the future we might be able to offer treatment early to stop them from happening. While it would be a number of years before this became a widely-available treatment option, this does offer real hope of another way to help people with type 1 diabetes have the best possible chance of a long and healthy life."

The next part of the AdDIT study will explore whether drugs that lower the amount of fat in the blood, such as statins, and drugs that reduce blood pressure, such as ACE inhibitors, reduce the risk of kidney and heart disease in adolescents with type 1 diabetes with these higher levels of albumin excretion.

More than 490,000 young people (0-14) worldwide have type 1 diabetes.* In the UK, nearly 25 children out of every 100,000 are diagnosed with the condition every year.**

### For additional information please contact: Genevieve Maul, Office of Communications, University of Cambridge
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Notes to editors:

1. The paper 'Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): Urinary screening and baseline biochemical and cardiovascular assessments' will be published in the 06 November edition of Diabetes Care.

2. * Diabetes Atlas 2012/ International Diabetes Federation ** Based on estimates from the International Diabetes Federation 3. JDRF exists to cure, treat and prevent type 1 diabetes, and is the world's leading charitable funder of type 1 diabetes research. At a global level JDRF volunteers and staff have been responsible for raising over £1 billion to support type 1 diabetes research since the charity's inception. 4. British Heart Foundation Coronary heart disease is the UK's single biggest killer. For over 50 years we've pioneered research that's transformed the lives of people living with heart and circulatory conditions. Our work has been central to the discoveries of vital treatments that are changing the fight against heart disease. But so many people still need our help. From babies born with life-threatening heart problems to the many Mums, Dads and Grandparents who survive a heart attack and endure the daily battles of heart failure. Every pound raised, minute of your time and donation to our shops will help make a difference to people's lives. Find out more at bhf.org.uk

5. Diabetes UK is the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes. For more information on all aspects of diabetes and access to Diabetes UK activities and services, visit http://www.diabetes.org.uk In the UK, there are around 3.8 million people who have diabetes. There are 3 million people living with Type 1 and Type 2 diabetes, and around 850,000 more who have Type 2 diabetes but don't know they have it because they haven't been diagnosed. As many as 7 million people are at high risk of developing Type 2 diabetes and if current trends continue, an estimated 5 million people will have Diabetes is a condition where there is too much glucose in the blood because the body cannot use it properly. If not managed well, both Type 1 and Type 2 diabetes can lead to devastating complications. Diabetes is the leading cause of blindness in people of working age in the UK and is a major cause of lower limb amputation, kidney failure and stroke. People with Type 1 diabetes cannot produce insulin. About 10 per cent of people with diabetes have Type 1. No one knows exactly what causes it, but it's not to do with being overweight and it isn't currently preventable. It usually affects children or young adults, starting suddenly and getting worse quickly. Type 1 diabetes is treated by daily insulin doses - taken either by injections or via an insulin pump – a healthy diet and regular physical activity. People with Type 2 diabetes don't produce enough insulin or the insulin they produce doesn't work properly (known as insulin resistance). 85 to 90 per cent of people with diabetes have Type 2. They might get Type 2 diabetes because of their family history, age and ethnic background puts them at increased risk. They are also more likely to get Type 2 diabetes if they are overweight. It starts gradually, usually later in life, and it can be years before they realise they have it. Type 2 diabetes is treated with a healthy diet and increased physical activity. In addition, tablets and/or insulin can be required. For more information on reporting on diabetes, download our journalists' guide: http://www.diabetes.org.uk/journalists-guide