No Benefit of ACE Inhibitors/Statins for Teens with Type 1 Diabetes

Treatment with angiotensin-converting enzyme (ACE) inhibitors, statins, or both does not affect albumin excretion in adolescents with type 1 diabetes, concludes a trial in The New England Journal of Medicine.

In a screening study of 4407 adolescents with type 1 diabetes, 1287 had increased albumin excretion, defined as the upper third of the albumin-to-creatinine ratio. Of these, 443 were randomly assigned to treatment with an ACE inhibitor, statin, or matching placebos in a 2-by-2 factorial design. The main outcome of interest was change in albumin excretion, assessed every 6 months over 2 to 4 years. Secondary outcomes included microalbuminuria, retinopathy, lipid levels, and other cardiovascular risk markers.

Change in albumin-to-creatinine ratio over time was unaffected by treatment with ACE inhibitor and/or statin. The incidence of microalbuminuria was lower with ACE inhibitor compared to placebo, but this difference was not considered significant. Statin treatment was associated with expected changes in lipid levels. However, there were no between-treatment differences in carotid intima-media thickness, other cardiovascular risk markers, glomerular filtration rate, or retinopathy progression. No serious unexpected adverse reactions occurred.

In adolescents with type 1 diabetes, puberty-associated increases in albumin excretion occur before the development of microalbuminuria and macroalbuminuria. This suggests that ACE inhibitors or statins might have beneficial effects for young diabetics with high albumin excretion.

However, the randomized, placebo-controlled trial shows no significant difference in albumin-to-creatinine ratio for young patients with type 1 diabetes taking ACE inhibitors or statins. Aside from statin-induced changes in lipid profiles, secondary outcomes are also similar between groups. The authors plan continued follow-up to assess any delayed “legacy effect” of early treatment [Marcovecchio ML, et al. ACE inhibitors and statins in adolescents with type 1 diabetes. N Engl J Med 2017; 377: 1733−1745].

January 2018 (Vol. 10, Number 1)