Risk factors

Teens with diabetes cope with the additional burden of CV protection

ACE inhibitors and statins are well tolerated in teenagers with type 1 diabetes but more evidence is required to demonstrate whether they are effective in preventing rapid increases in albumin excretion and associated complications leading to cardiovascular disease.

According to the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT), the use of an ACE inhibitor, statin or a combination of the two medications did not change the albumin excretion rate over the two-to-four year study period in teenagers at high risk for albuminuria.

The 443 adolescents randomised into the study were screened from a larger group of over 4,000 ten to 16 year olds and shown to have the highest albumin-to-creatinine ratios (ACR) after adjustment for age, sex and duration of diabetes.

Professor Tim Jones, co-director of the Children’s Diabetes Centre at the Telethon Kids Institute in Western Australia, told the limbic while the primary outcome was negative, there were important learnings from the trial.

“The positive message is that we can identify young adolescents at higher risk very early on in their diabetes careers – when ACRs are very much still in the normal range and will be normal for a number of years.”

“We’d like to get that formulae into people’s clinics to identify high risk groups early. We shouldn’t wait until there are significant levels of microalbuminuria.”

The study found statin treatment resulted in significant reductions in total, low-density and non-high density lipoprotein cholesterol, triglycerides and apolipoprotein B to apolipoprotein A1 ratio.

Statin therapy was not associated with any serious side effects.

ACE inhibitor doses had to be reduced initially in some patients due to postural hypotension but only 5% were unable to tolerate the full 10mg by the end of the trial.

“Physicians can be comfortable that these drugs are safe in this age group and consider using them early if there are any signs of progression or comorbidities like hypertension or hyperlipidaemia.”

He said the rate of complications in adolescents with diabetes had reduced considerably in the last few years.

“But we still think it’s a time when we should be putting in some protection in the high risk groups, so if we can pick them at 10, 11 or 12 years perhaps we should intensify their treatment and look at treating very small changes in blood pressure or lipids early.”

He said the research team was very keen to follow participants into adulthood, as it was possible the initial follow-up was just not long enough to demonstrate any change in ACR.

The study said ‘…long-term follow-up of the cohort will be important to assess whether intervention during this critical period of adolescence will result in a ‘legacy effect’ similar to that observed after previous trials investigating glycemic and lipid control’.

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