High albumin levels, but within the normal range, can be used to identify young people with type 1 diabetes at risk of heart and kidney disease, according to a study published online ahead of print in Diabetes Care. Screening may enable early intervention, the authors suggested.
While elevated albumin levels 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.
"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," said lead author David Dunger, MD, University of Cambridge. "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," Dr. Dunger said.
The study involved 3,353 adolescents (10 to 16 years old) with type 1 diabetes enrolled in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT). As part of preliminary screening for this randomized controlled trial of ACE inhibitors/statins for the prevention of cardiovascular and kidney disease, the patients were assessed for albumin-creatinine ratio (ACR), as well as early markers of atherosclerosis and kidney dysfunction.
Higher ACR Linked to Early Kidney and Cardiovascular Complications
They found that adolescents with type 1 diabetes whose albumin-creatinine ratios (ACR) were in the top tertile of the normal range showed significantly higher pulse wave velocity, non-HDL cholesterol levels, and apoliprotein A/apolipoprotein A-1 ratio than patients with lower ACR. In addition, patients in the top ACR tertile showed significantly decreased cystatin C, creatinine, and estimated glomerular filtration rate.
Next, the researchers will explore whether medications such as statins and ACE inhibitors reduce the risk of kidney and heart disease in adolescents with type 1 diabetes with high levels of albumin excretion.
"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," commented Dr. Alasdair Rankin, Director of Research for Diabetes UK, which helped fund the study. "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," Dr.Rankin said.
Marcovecchio ML, Woodside J, Jones T, et al. Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT): Urinary screening and baseline biochemical and cardiovascular assessments. Diabetes Care. 2013 Nov 6. [Epub ahead of print]