Finding the sweet spot for teens with diabetes: improving diabetes control and preventing complications

There are more than 300,000 Canadians living with Type 1 diabetes. People with Type 1 diabetes face a significant level of self-care to keep their blood glucose levels normal. They must inject themselves with insulin several times per day or use insulin pumps, and despite their best efforts, these patients sometimes experience serious complications. Teen patients face particular stressors unique to adolescence such as psychological, social and developmental changes, and as a result are known to have the poorest blood sugar control. The teen years are a critical period of time when long-term diabetes-related complications may begin and progress. Drs. Denis Daneman and Farid Mahmud of The Hospital for Sick Children (SickKids) participated in a world-first global study of teens with diabetes to identify possible interventions to improve health outcomes of this vulnerable patient population.

The first study, Adolescent Diabetes Cardio-Renal Intervention Trial (AdDIT) investigated if the use of statins (lipid-lowering medications) could protect against future diabetes complications, including early signs of kidney and cardiovascular disease. Published in the New England Journal of Medicine in November 2017, the results showed that neither of the medications used in the trial were effective in reducing markers of kidney or cardiovascular disease. However the study achieved remarkable levels of engagement with the target population of teens. Over 4,400 teenagers across three continents participated in the study with a 75 per cent compliance rate.

The results of this research and valuable experience working collaboratively with teen patients with diabetes and their families positioned Mahmud, a specialist in paediatric endocrinology, and his colleagues at SickKids to design the Adolescent Type 1 Diabetes Treatment with Empagliflozin for Hyperglycemia and Hyperfiltration (ATTEMPT) Trial.

This next trial will examine the effects of Empagliflozin on adolescents and young adults with Type 1 diabetes who are at a higher risk of developing complications, such as kidney and heart disease.

“ATTEMPT will evaluate the impact of Empagliflozin that has been developed for use in adults with Type 2 diabetes and has been shown to have significant health benefits,” says Mahmud, who is also an Associate Professor at the University of Toronto

Developed with patient partners and designed to evaluate important diabetes outcomes as identified by patients and families, the ATTEMPT Trial will enroll 100 adolescent patients over three years at SickKids and other health-care centres in Ontario. If successful, the project will be the first academically-led North American trial to use this method to treat adolescents and evaluate if these agents are effective and safe in the treatment of Type 1 diabetes in youth.

“As the lead AdDIT site in Canada, our research team at SickKids will work closely with investigators at the University Health Network (UHN), to evaluate participants over the next five years and collect ongoing information for kidney and cardiovascular disease,” says Mahmud who is also an Associate Scientist at the Hospital for Sick Children Research Institute. “Our goal is to identify successful interventions to improve health outcomes.”

This research was funded by Juvenile Diabetes Research Foundation (JDRF), Canadian Institutes for Health Research (CIHR) as part of the Strategies for Patient Oriented Research (SPOR) Program, and the SickKids Foundation. It is an example of how SickKids is contributing to making Ontario Healthier, Wealthier and Smarter. www.healthierwealthiersmarter.com