NIDDK Director's Update Winter 2021

Research Updates

Youth diabetes prevalence and mortality rates assessed in SEARCH for Diabetes in Youth study

A diverse group of teenagers.

New research from the SEARCH for Diabetes in Youth study show that the number of youths living with diabetes in the United States continues to rise. Between 2001 and 2017, the proportions of type 1 and type 2 diabetes increased among U.S. youth under age 20 across all sex, age, and race and ethnicity groups. The number of youths under age 20 living with type 1 diabetes increased by 45%, while the number of those between the ages 10 and 19 with type 2 diabetes grew by 95%. The greatest increases in type 1 diabetes were among Black youths and White youths, while for type 2 diabetes, increases were greatest among Black youths and Hispanic youths. This work was published in the JAMA in August.

Additionally, SEARCH researchers recently published findings that showed youths and young adults with diabetes experience higher rates of death compared with their peers living in the same communities. While death overall was uncommon, after 8 years post-diagnosis, deaths were 1.5 times greater for youths with type 1 diabetes, 2.3 times greater for type 2 diabetes, and 28 times greater for youths with secondary diabetes than with youths and young adults in the same time period in comparable regions of the United States. Secondary diabetes is caused by conditions such as cystic fibrosis, pancreatitis, genetic syndromes, and some medications. The research was published in Diabetes Care in October.

Studies suggests alternative to race-based kidney function calculations

A photo of a blood sample vial ready for estimated glomerular filtration rate, or eGFR, testing.
A blood sample is ready for estimated glomerular filtration rate, or eGFR, testing. Current eGFR tests use race as a variable, but NIH-funded research suggests using an additional alternative biomarker in eGFR would produce non-biased results without the use of a race variable.
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In two recent NIDDK-supported studies, researchers propose changing a key measure in kidney disease diagnosis and treatment to eliminate the use of race as a variable, providing a non-biased kidney function test that does not compromise accuracy. The studies suggest incorporating use of a blood lab test called cystatin C, which unlike creatinine, does not vary by a person’s race, along with a measurement of creatinine, can provide a more accurate race-free eGFR calculation. Creatinine is currently is used by health care providers in estimated glomerular filtration rate, or eGFR, calculations – a primary diagnostic tool to learn how well a person’s kidneys function and to classify the severity of their disease, from mild loss of kidney function to end-stage kidney disease. The eGFR also helps determine prognosis and treatment, such as when hemodialysis or a transplant may be needed, as well as determining certain drug dosings. The findings come from detailed analyses of data from the Chronic Renal Insufficiency Cohort (CRIC) Study, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), both published in the November 4, 2021 issue of the New England Journal of Medicine.

Metformin and lifestyle interventions in the Diabetes Prevention Program do not lower death rates

Diabetic kit: glucometer, test strips, lancet, metformin tablets.
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After 21 years of follow-up, participants in the Diabetes Prevention Program (DPP) who were randomized to metformin or lifestyle change interventions did not have reduced rates of death from all causes, cardiovascular disease, or cancer compared to participants randomized to the placebo group. Researchers from the DPP Outcomes Study analyzed data from 3,234 adults at high risk for developing diabetes who were enrolled in the DPP. Among the 453 participants who had died by the end of 2018, cancer was the leading cause of death (37%), followed by cardiovascular disease (29%). In addition to the death rates being similar across all three original groups, the risks for mortality among the metformin and lifestyle change groups compared to placebo did not differ by age, sex, race/ethnicity, or BMI. This research was published in Diabetes Care in October.

New NIH research identifies potential biomarker of diabetic kidney disease

Led by NIDDK scientists in Phoenix, a recent study found that a modified form of the protein PTEN was associated with both a greater risk of decline in kidney function and the development of kidney failure in American Indians with type 2 diabetes. In a small subgroup of participants, the modified PTEN was associated with changes in kidney structure that reflect some of the earliest signs of diabetic kidney disease. The findings suggest that this modified protein could be a useful screening biomarker in identifying patients at the early stages of diabetic kidney disease when they may respond better to treatment. The study also provides insight into the pathways involved in progression of diabetic kidney disease. This research was published in the American Journal of Kidney Diseases in September.

Type 2 diabetes puts youth at high risk for early diabetes complications

A woman holding a glucometer on her finger.
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New findings from the NIH-supported Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) follow up study have added to understanding of diabetes complications among participants. One study, published in Diabetes Care in October, analyzed data from annual assessments for diabetic peripheral neuropathy. This condition was seen in 3% of participants at the first assessment, with the rate increasing over time, with 38.5% of male and 28.2% of female participants having peripheral neuropathy within 15 years of their initial diabetes diagnosis. The risk of neuropathy was associated with glycemic control.

Another study conducted among a subset of TODAY participants who had signs of cardiovascular complications at their seven-year study visit showed worsening of the condition over the next five years. The changes were associated with high blood pressure and glycemic control regardless of the sex or race/ethnicity of the participant. This study was published in Acta Diabetologica in September.

Studies analyzing risks of diabetic kidney disease and retinopathy were also published in Diabetes Care in September.

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