ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 10.15 | DOI: 10.1530/ey.15.10.15

Department of Paediatrics and the Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge UK


To read the full abstract: New Engl J Med 2017; 377:1733-1745

We are still unable to reach treatment goals in all children and adolescents with T1DM. The usually earliest microvascular complication developed in adolescents and young adults is microalbuminuria. Therefore this trial focused on the prevention of microalbuminuria in high risk adolescents with an albumin-to-creatinine ratio in the upper third with an ACE inhibitor. Using a 2x2 factorial design, they tested the influence of statins and an ACE-inhibitor on microalbuminuria, intima media thickness, lipids and other cardiovascular risk factors.

Neither ACE inhibitor nor statin reduced the albumin-to-creatinine ratio. ACE inhibitors reduced the incidence of microalbuminuria by 43%, but that was not considered statistical significant due to the null results on the primary outcome. This result has to be discussed in the knowledge of recent data from the DCCT, which show that even intermittent microalbuminuria predicts cardiovascular disease risk in T1DM. A delayed legacy effect of early treatment with ACE inhibitors or statins could still occur, as reported in other trials. Therefore follow-up of the study cohort will be essential to evaluate the potential benefits of early intervention with ACE inhibitors and statins.

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