title: Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): urinary screening and baseline biochemical and cardiovascular assessments.
abstract: OBJECTIVE
  We assessed the association between early increases in albumin excretion and cardiovascular (CV) and renal markers in a large cohort of young people with type 1 diabetes.
  
  
  METHODS
  As part of preliminary screening for a multicenter, randomized controlled trial of statins/ACE inhibitors, we measured albumin-creatinine ratio (ACR) in six early morning urine samples from 3,353 adolescents (10-16 years of age) and calculated tertiles based on an established algorithm. From those subjects deemed to be at higher risk (upper ACR tertile), we recruited 400 into the intervention study (trial cohort). From those subjects deemed to be at lower risk (middle-lower ACR tertiles), we recruited 329 to the observation cohort. At baseline, vascular measurements (carotid intima-media thickness, pulse wave velocity [PWV], flow-mediated dilatation, digital pulse amplitude tonometry), renal markers (symmetric dimethylarginine, cystatin C, creatinine), and CV disease markers (lipids and apolipoproteins [Apo] A-1 and B, C-reactive protein, asymmetric dimethylarginine) were assessed.
  
  
  RESULTS
  Age- and sex-adjusted PWV was higher in the trial than in the observational cohort (5.00 ± 0.84 vs. 4.86 ± 0.70 m/s; P = 0.021). Similarly, non-HDL cholesterol (2.95 ± 0.83 vs. 2.81 ± 0.78 mmol/L; P = 0.02) and ApoB-ApoA-1 ratio (0.50 ± 0.14 vs. 0.47 ± 0.11; P = 0.04) were higher in the trial cohort. Cystatin C and creatinine were decreased (0.88 ± 0.13 vs. 0.90 ± 0.13 mg/L, P = 0.04; 51.81 ± 10.45 vs. 55.35 ± 11.05 μmol/L, P < 0.001; respectively) and estimated glomerular filtration rate (137.05 ± 23.89 vs. 129.31 ± 22.41 mL/min/1.73 m(2); P < 0.001) increased in the trial compared with the observational cohort.
  
  
  CONCLUSIONS
  Our data demonstrate that in adolescents with type 1 diabetes, the group with the highest tertile of albumin excretion showed more evidence of early renal and CV disease than those in the lower tertiles.
authors.affiliation: Corresponding author: David B. Dunger, dbd25@cam.ac.uk.
authors.forename: M Loredana
authors.initials: ML
authors.lastname: Marcovecchio
authors.forename: John
authors.initials: J
authors.lastname: Woodside
authors.forename: Timothy
authors.initials: T
authors.lastname: Jones
authors.forename: Denis
authors.initials: D
authors.lastname: Daneman
authors.forename: Andrew
authors.initials: A
authors.lastname: Neil
authors.forename: Toby
authors.initials: T
authors.lastname: Prevost
authors.forename: R Neil
authors.initials: RN
authors.lastname: Dalton
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.forename: David B
authors.initials: DB
authors.lastname: Dunger
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000175:diagnosis*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016632:Apolipoprotein A-I / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D003404:Creatinine / Q000652:urine; D055316:Cystatin C / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D011236:Prediabetic State / Q000175:diagnosis; D063177:Pulse Wave Analysis; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D016632:Apolipoprotein A-I; D015415:Biomarkers; D055316:Cystatin C; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein; D003404:Creatinine