Risk assessment, which includes identifying the stage to which the disease has progressed in the individual patient, is just as important in children and adolescents as it is in adults. If we can identify individuals who are at an increased risk of developing a specific complication, or who already show early signs of complications, action can be taken to address this, including the use of additional and/or more intensive treatment.
The ‘Early Detection of Diabetes Damage in Youth and Search for early prevention‘ (EDDDY-S) study was a research project designed to find ways to help clinicians better assess risks in children and adolescents with type 1 diabetes. It investigated new techniques for identifying early signs of micro- and macrovascular complications. Traditionally, surrogate endpoints and early signs of complications have included HbA1c, neurological physical examination, albumin excretion ratio (AER), atherogenic profile, objective neurological examination.
Newer endpoints and early signs include Advanced glycation endproducts (AGEs: measure by auto-fluorescence), intima-media thickness of the carotid artery (cIMT), markers reflecting endothelial dysfunction and measuring endothelial dysfunction itself, flow-mediated dilation (FMD) of the brachial artery, measures for arterial stiffness by pulse-wave analysis, measurement of Cystatine C and C-peptide, corneal nerve fibre density (CNFD) and corneal nerve fibre branch density (CNFBD), corneal sensation threshold measurements, new methods to measure vibration perception threshold, testing tactile function with smaller (1 mN) rather than thicker monofilaments and determining retinal vascular geometry.
Sub-studies of EDDDY-S addressed some of these newer endpoints/signs, with the aim of investigating their applicability in children and adolescents with type 1 diabetes, and if they can be usefully integrated along with older endpoints/signs into a more effective staging system for risk assessment.
Diabeter is ideally placed to conduct such research: the sub-study populations include patients attending our outpatient clinics, with the new tests and evaluations incorporated into the standard battery of assessments.
Originally thought to result from a complete loss of beta-cells due to a specific immune attack on these cells, type 1 diabetes has been found to involve various beta-cell-specific processes, different genetic predispositions, and several disease stages. In order to tailor treatment, it is essential to find biomarkers to identify this heterogeneity, different phases of disease and the effects of interventions and cures. To this end the JDRF-funded BIOMARKER study was initiated in collaboration with the University Medical Center Groningen (UMCG).