The Adolescent Cardio-Renal Intervention Trial (AdDIT): retinal vascular geometry and renal function in adolescents with type 1 diabetes

The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT), AdDIT investigators in Australia, AdDIT investigators in the UK, AdDIT investigators in Canada, Paul Z. Benitez-Aguirre, Tien Y. Wong, Maria E. Craig, Elizabeth Davis, Andrew Cotterill, Jennifer Couper, Fergus Cameron, Farid Mahmud, Tim W. Jones, Lauren A.B. Hodgson, R. Neil Dalton, David Dunger, Kim C. Donaghue, Sally Marshall, Jane Armitage, Polly BingleyWilliam Van’t Hoff, David Dunger, Denis Daneman, Andrew Neil, John Deanfield, Kim Donaghue, Maria Craig, Paul Benitez-Aguirre, Fergus Cameron, Jennifer Couper, Charles Verge, Phil Bergman, Christine Rodda, M. Loredana Marcovecchio, Scott Chiesa, Carlo Acerini, Fran Ackland, Binu Anand, Tim Barrett, Virginia Birrell, Fiona Campbell, Marietta Charakida, Tim Cheetham, Chris Cooper, Ian Doughty, Atanu Dutta, Julie Edge, Alastair Gray, Julian Hamilton-Shield, James Heywood, Nicola Leech, Nick Mann, Richard Parker, Gerry Rayman, Jonathon Mark Robinson, Michelle Russell-Taylor, Vengudi Sankar, Anne Smith, Nandu Thalange, Mark Wilson, Chandan Yaliwal, Farid Mahmud, Cheril Clarson, Jacqueline Curtis, Etienne Sochett

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Aims/hypothesis: We examined the hypothesis that elevation in urinary albumin creatinine ratio (ACR) in adolescents with type 1 diabetes is associated with abnormal retinal vascular geometry (RVG) phenotypes. Methods: A cross-sectional study at baseline of the relationship between ACR within the normoalbuminuric range and RVG in 963 adolescents aged 14.4 ± 1.6 years with type 1 diabetes (median duration 6.5 years) screened for participation in AdDIT. A validated algorithm was used to categorise log10 ACR into tertiles: upper tertile ACR was defined as ‘high-risk’ for future albuminuria and the lower two tertiles were deemed ‘low-risk’. RVG analysis, using a semi-automated computer program, determined retinal vascular calibres (standard and extended zones) and tortuosity. RVG measures were analysed continuously and categorically (in quintiles: Q1–Q5) for associations with log10 ACR and ACR risk groups. Results: Greater log10 ACR was associated with narrower vessel calibres and greater tortuosity. The high-risk group was more likely to have extended zone vessel calibres in the lowest quintile (arteriolar Q1 vs Q2–Q5: OR 1.67 [95% CI 1.17, 2.38] and venular OR 1.39 [0.98, 1.99]) and tortuosity in the highest quintile (Q5 vs Q1–Q4: arteriolar OR 2.05 [1.44, 2.92] and venular OR 2.38 [1.67, 3.40]). The effects of retinal vascular calibres and tortuosity were additive such that the participants with the narrowest and most tortuous vessels were more likely to be in the high-risk group (OR 3.32 [1.84, 5.96]). These effects were independent of duration, blood pressure, BMI and blood glucose control. Conclusions/interpretation: Higher ACR in adolescents is associated with narrower and more tortuous retinal vessels. Therefore, RVG phenotypes may serve to identify populations at high risk of diabetes complications during adolescence and well before onset of clinical diabetes complications.

Original languageEnglish
Pages (from-to)968-976
Number of pages9
JournalDiabetologia
Volume61
Issue number4
DOIs
Publication statusPublished - 1 Apr 2018

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