ESPE Abstracts (2019) 92 S4.3

Prediction of Renal and Cardiovascular Complications

Loredana Marcovecchio

University of Cambridge, United Kingdom

Vascular complications continue to be a major concern for young people with type 1 diabetes (T1D), who have a decreased life expectancy, by 8-16 years, compared to the background population. Diabetic nephropathy and cardiovascular disease are main contributors to morbidity and mortality in people with T1D. Thus, early detection and prevention of complications are of paramount importance to improve their long-term prognosis.

Although HbA1c is a major risk factor, and the main focus of current screening and treatment strategies, suboptimal glycaemic control is a common problem among young people with T1D, and there is a clear need for improved markers to identify subjects at risk. Evidence is accumulating that early increases in urinary albumin excretion, still within the normal range, could identify adolescents with T1D who are at an increased risk of complications, independently of HbA1c. In young people with childhood-onset T1D, early increases in urinary albumin excretion can occur during the first years after diagnosis and they can predict future risk of vascular complications. Recent data from the cohort of adolescents recruited into the Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT) support the value of albumin excretion as an early renal, retinal and cardiovascular marker. In the AdDIT cohort of around 800 adolescents with T1D, an albumin excretion in the top tertile of the normal range was associated with renal outcomes, such as microalbuminuria and hyperfiltration, as well as with a worse cardiovascular profile and retinopathy progression during a 2-4 years follow-up period. These data support the concept that risk stratification using urinary albumin excretion during early adolescence may be critical for the early identification of patients at risk of vascular complications, and to guide the implementation of preventive and treatment strategies.

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