Understanding kidney disease risks facing youth with diabetes

Diabetes is the most common cause of kidney disease in North America. With rates of both type 1 and type 2 diabetes on the rise among children, many youth and their families are concerned about long-term kidney health.

If kidney disease is identified early, treatment can help slow its progression. However, we are not yet able to predict who is at greatest risk.

Two research teams, AdDIT and iCARE, are working together through the Can-SOLVE CKD Network to define kidney disease risk in adolescents with diabetes. By looking at a range of biological, psychological, and social factors, the teams aim to understand which youth are at risk in order to develop strategies that can prevent or delay complications.

Adolescent Diabetes Cardio-Renal Intervention Trial

Many diabetes complications start and progress during the teenage years, making this a crucial time to begin treatment. The Adolescent Diabetes Cardio-Renal Intervention Trial (AdDIT) is focused specifically on reducing heart and kidney disease risk for teens with type 1 diabetes.

Quick facts: AdDIT

  • An international study with sites in Canada, Australia, and the United Kingdom
  • Canadian coordinating centre is based at The Hospital for Sick Children (SickKids) in Toronto

AdDIT has completed an initial study assessing the benefits of early treatment with medications to lower blood pressure and cholesterol. Patients receiving these medications were evaluated over four years for complications related to heart and kidney disease compared to an observational group receiving a placebo. Among the outcomes measured were kidney function, cardiac function, blood pressure, cholesterol, medication adherence, and how patients manage their diabetes.

The next phase of AdDIT will follow up with all study participants for five years to assess the longer-term impact of the medication intervention on heart and kidney disease risk.

Improving Renal Complications in Adolescents with Type 2 Diabetes through Research

While type 2 diabetes is generally thought of as an adult condition, it is becoming more prevalent in children. This is concerning, as children with type 2 diabetes generally experience poorer outcomes than those with type 1 diabetes. About 50 percent of children with type 2 diabetes end up on dialysis by their mid-30s.

Quick facts: iCARE

  • A national study based in Winnipeg with significant participation from Manitoba and northwestern Ontario
  • Expanding to eight sites across Canada from BC to Nova Scotia

Improving Renal Complications in Adolescents with Type 2 Diabetes through Research (iCARE) is a national study aiming to recruit 400 children with type 2 diabetes across Canada. The study will follow participants for two years and assess both heart and kidney outcomes using the same metrics as AdDIT.

“This collaboration with AdDIT is important, because we’re able to compare clinical features as well as biomarkers between the two types of diabetes to really figure out which children are at highest risk,” says Dr. Allison Dart, principal investigator of iCARE. “Potentially this could lead to new treatments for the highest risk kids.”

Putting patients at the centre

Patient engagement has been front and centre in both studies through the creation of advisory councils consisting of patients and their families. These councils ensure patients are able to participate in all aspects of the research process and have a strong voice in shaping the research agenda.

“Our patient partners have been a great resource for us to ensure we’re asking the right questions,” says AdDIT investigator Dr. Farid Mahmud.

Both projects’ advisory councils have helped the researchers understand the outcomes that are of interest to patients, as well as how to measure them. One insight that emerged from patient input was the importance of mental health and social factors that relate to heart and kidney outcomes.

“We all recognize this is a vibrant group of people who have their whole lives ahead of them,” says Mahmud. “It’s important to understand both their medical histories but also to understand the stressors in their lives and to be able to understand the impact of other factors such as the social determinants of health.”

iCARE’s advisory group has presented at local research days and recently produced a video to dispel some of the myths about type 2 diabetes.

“The advisory group was really critical to ensure that mental health was a component throughout,” says Dart. “They gave us a lot of feedback about the measures that we used to help us decide which ones we should be using and what was appropriate.”

Want to learn more? Check out this webinar presentation by the AdDIT and iCARE teams: “Defining CKD Risk in Youth with Diabetes”

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