The iCARE study team

The teenage years of a person’s life are critical for shaping their health and well-being as adults, and this can be especially true for adolescents living with diabetes.

A range of physical, psychological and social factors have the potential to influence the trajectory of a person’s disease during this important stage of life, including the progression of secondary complications such as kidney disease. Two studies through Can-SOLVE CKD are striving to tease apart these factors and identify possible ways to limit the development of diabetes-associated kidney disease.

Adolescent Type-1 Diabetes Cardio-Renal Intervention Trial (AdDIT)

In the first study, the Adolescent Type-1 Diabetes Cardio-Renal Intervention Trial (AdDIT), teenagers were given two medications that may have the potential to slow progression of kidney disease. Results suggest that one of the drugs, called an ACE inhibitor, has a beneficial effect at limiting progression of microalbuminuria, a condition where some excess nutrients leak from the kidneys. Microalbuminuria is an early sign of kidney disease.

But studying the effects of preventative drugs is just one component of AdDIT. With so many teenagers enrolled – more than 350 – the study is a prime opportunity to explore what factors may contribute to diabetes-associated complications during adolescence. Through blood and urine samples, for example, the researchers are trying to identify certain proteins and other indicators (called biomarkers) associated with kidney disease. This may lead to better monitoring of disease, and perhaps one day more targeted therapies.

Dr. Farid Mahmud, a researcher at SickKids Hospital in Toronto who is co-leading the study with Dr. Etienne Sochett, also notes that teenagers face a number of stresses during this time in their life, as they become young adults. “We’ve found and published recently that these social and economic factors that influence people’s health are significant contributors to some of the risks, such as early kidney and heart disease, that these patients face in terms of progression of their diabetes complications,” he says. For these reasons, the study is also monitoring psychosocial factors in order to better understand how these may contribute to the long-term physical health of teenagers with diabetes.

Improving Renal Complications in Adolescents with Type 2 Diabetes through Research (iCARE)

A second study called Improving Renal Complications in Adolescents with Type 2 Diabetes through Research (iCARE), which is co-led by Dr. Allison Dart and Dr. Brandy Wicklow at the University of Manitoba, delves further into the psychosocial factors that may contribute to diabetes-associated kidney disease in youth with type 2 diabetes. The first phase of this observational study evaluated biological, mental health and social factors that might have influenced their kidney disease. The results suggest that biological factors like blood pressure and blood sugar are associated with protein in the urine, an indication of kidney disease. However, the results also suggest that mental health factors may also indirectly be associated with protein in the urine, for example by causing stress and causing inflammation in the body.

Notably, many participants in this study are Indigenous, and have the added challenge of living with multi-generational traumas.

“This study is important because it’s broadening the evaluation to a biopsychosocial model,” explains Dart. “Our patient partners have told us that mental health is very, very important, and that social supports are not always there. And so we’re trying to understand what role mental health and social context, both historical and current, might play in determining the complications that these kids have.”

PRO-Kid: A symptom assessment tool for children

Dart also co-chairs the Can-SOLVE CKD Pediatrics Committee with Dr. Michael Zappitelli, which has taken on a unique project to develop a symptom assessment tool for children with kidney disease, called PRO-Kid. While one of Can-SOLVE CKD’s core 18 research projects involves evaluating a symptom assessment tool for adults, such a resource was lacking for children. As Dart notes, children may not understand the wording and how to rate their symptoms using the adult version of the tool.

“So we’ve developed a template, and now we’re doing cognitive interviews with children with kidney disease and their parents to get input on whether the questionnaire as we’ve developed it makes sense,” explains Dart. “At the end we will have a pediatric focused, objective measure of symptoms in kids with kidney disease.”

PRO-Kid is funded through a grant from the Children’s Hospital Research Institute of Manitoba, and is being co-led by Mina Matsuda-Abedini at SickKids Hospital in Toronto.

Together, all three of these projects aim to ensure that care providers understand the importance of a holistic approach to caring for children with diabetes and kidney disease, and to guide new intervention strategies that will ultimately lead to improved outcomes for patients. To learn more about what patients living with youth onset type 2 diabetes are facing, you can watch this YouTube video made by the iCARE patient advisory group.

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