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

Research output: Contribution to journalArticle

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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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Retinal Vessels
Type 1 Diabetes Mellitus
Albumins
Creatinine
Kidney
Diabetes Complications
Phenotype
Albuminuria
Blood Glucose
Software
Cross-Sectional Studies
Odds Ratio
Blood Pressure

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The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT), AdDIT investigators in Australia, AdDIT investigators in the UK, & AdDIT investigators in Canada (2018). The Adolescent Cardio-Renal Intervention Trial (AdDIT): retinal vascular geometry and renal function in adolescents with type 1 diabetes. Diabetologia, 61(4), 968-976. https://doi.org/10.1007/s00125-017-4538-2
The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) ; AdDIT investigators in Australia ; AdDIT investigators in the UK ; AdDIT investigators in Canada. / The Adolescent Cardio-Renal Intervention Trial (AdDIT) : retinal vascular geometry and renal function in adolescents with type 1 diabetes. In: Diabetologia. 2018 ; Vol. 61, No. 4. pp. 968-976.
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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.",
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The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT), AdDIT investigators in Australia, AdDIT investigators in the UK & AdDIT investigators in Canada 2018, 'The Adolescent Cardio-Renal Intervention Trial (AdDIT): retinal vascular geometry and renal function in adolescents with type 1 diabetes' Diabetologia, vol. 61, no. 4, pp. 968-976. https://doi.org/10.1007/s00125-017-4538-2

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.

In: Diabetologia, Vol. 61, No. 4, 01.04.2018, p. 968-976.

Research output: Contribution to journalArticle

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T1 - The Adolescent Cardio-Renal Intervention Trial (AdDIT)

T2 - retinal vascular geometry and renal function in adolescents with type 1 diabetes

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

AU - AdDIT investigators in Australia

AU - AdDIT investigators in the UK

AU - AdDIT investigators in Canada

AU - Benitez-Aguirre, Paul Z.

AU - Wong, Tien Y.

AU - Craig, Maria E.

AU - Davis, Elizabeth

AU - Cotterill, Andrew

AU - Couper, Jennifer

AU - Cameron, Fergus

AU - Mahmud, Farid

AU - Jones, Tim W.

AU - Hodgson, Lauren A.B.

AU - Dalton, R. Neil

AU - Dunger, David

AU - Donaghue, Kim C.

AU - Marshall, Sally

AU - Armitage, Jane

AU - Bingley, Polly

AU - Van’t Hoff, William

AU - Dunger, David

AU - Daneman, Denis

AU - Neil, Andrew

AU - Deanfield, John

AU - Jones, Tim

AU - Donaghue, Kim

AU - Craig, Maria

AU - Benitez-Aguirre, Paul

AU - Cameron, Fergus

AU - Couper, Jennifer

AU - Davis, Elizabeth

AU - Verge, Charles

AU - Bergman, Phil

AU - Rodda, Christine

AU - Marcovecchio, M. Loredana

AU - Chiesa, Scott

AU - Acerini, Carlo

AU - Ackland, Fran

AU - Anand, Binu

AU - Barrett, Tim

AU - Birrell, Virginia

AU - Campbell, Fiona

AU - Charakida, Marietta

AU - Cheetham, Tim

AU - Cooper, Chris

AU - Doughty, Ian

AU - Dutta, Atanu

AU - Edge, Julie

AU - Gray, Alastair

AU - Hamilton-Shield, Julian

AU - Heywood, James

AU - Leech, Nicola

AU - Mann, Nick

AU - Parker, Richard

AU - Rayman, Gerry

AU - Robinson, Jonathon Mark

AU - Russell-Taylor, Michelle

AU - Sankar, Vengudi

AU - Smith, Anne

AU - Thalange, Nandu

AU - Wilson, Mark

AU - Yaliwal, Chandan

AU - Mahmud, Farid

AU - Clarson, Cheril

AU - Curtis, Jacqueline

AU - Sochett, Etienne

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

KW - AdDIT

KW - Adolescents

KW - Diabetic retinopathy

KW - Microvascular complications

KW - Nephropathy

KW - Retinal vascular geometry

KW - Type 1 diabetes

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U2 - 10.1007/s00125-017-4538-2

DO - 10.1007/s00125-017-4538-2

M3 - Article

VL - 61

SP - 968

EP - 976

JO - Diabetolgia

JF - Diabetolgia

SN - 0012-186X

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ER -

The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT), AdDIT investigators in Australia, AdDIT investigators in the UK, AdDIT investigators in Canada. The Adolescent Cardio-Renal Intervention Trial (AdDIT): retinal vascular geometry and renal function in adolescents with type 1 diabetes. Diabetologia. 2018 Apr 1;61(4):968-976. https://doi.org/10.1007/s00125-017-4538-2