Innovative Test That Could Predict Risk of Kidney Failure in Pediatric Type 1 Diabetes Patients Announced at 68th AACC Annual Scientific Meeting

PHILADELPHIA, Aug. 2, 2016 /PRNewswire-USNewswire/ -- Researchers have successfully tested a new method for the early diagnosis in children and teenagers of diabetic nephropathy, a serious complication of diabetes that can increase risk of death. This new method, unveiled today at the 68^th AACC Annual Scientific Meeting & Clinical Lab Expo, would help pediatric patients get necessary treatment in a more timely manner.

Diabetic nephropathy affects 20–40% of type 1 and 2 diabetic patients. In type 1 diabetic patients who have progressed to the final stages of nephropathy, kidney failure eventually develops in 50% of individuals within 10 years after the onset of overt nephropathy and in >75% by the 20 year mark. Currently, this condition is diagnosed through the detection of increased urinary albumin excretion, but a growing body of evidence suggests that the risk for developing diabetic nephropathy starts when urinary albumin excretion levels are still within the normal range. If the onset of nephropathy could be detected before urinary albumin rises, patients could potentially be placed on treatment to prevent its development.

A team of researchers led by Ioannis Papassotiriou, PhD, of Aghia Sophia Children's Hospital in Athens, Greece, has determined that two proteins—growth differentiation factor-15 (GDF-15) and chitinase-3-like protein 1 (YKL-40)—could be used to detect diabetic nephropathy early. In 56 type 1 diabetes patients ages 9–15 and 49 healthy controls ages 6–19, the researchers tested for GDF-15 and YKL-40 at time of enrollment in the study and after 12–15 months. Also at these two time points, they evaluated subjects' kidney function by measuring cystatin C to determine estimated glomerular filtration rate (eGFR) and measuring neutrophil gelatinase associated lipocalin (NGAL).

After 12–15 months, the researchers found that GDF-15 levels in diabetes patients were significantly higher (366.7 pg/mL) than in healthy controls (278.6 pg/mL). Initially, no significant difference in YKL-40 measurements was observed between diabetes patients and controls at time of enrollment, but over the course of the study, mean YKL-40 levels in diabetes patients proceeded to increase (from 17.4 ng/mL to 20.5 ng/mL). GDF-15 levels also correlated negatively with eGFR values, while YKL-40 levels correlated positively with NGAL and GDF-15, indicating that rises in both proteins reflect a decline in kidney function.

"This is the first study to demonstrate a predictive role for serum GDF-15 and YKL-40 as early markers of diabetic nephropathy in children and adolescents with [type 1 diabetes] before severe overt nephropathy occurs," said Papassotiriou. "Defining new predictors as supplementary tests to urinary albumin excretion for the early diagnosis of diabetic nephropathy could accelerate effective management and treatment approaches needed to minimize the rates of severe renal morbidity and mortality in young patients with [type 1 diabetes]."

In addition to this study, researchers will present the latest in diabetes testing at the AACC Annual Scientific Meeting & Clinical Lab Expo, including:

• Preliminary findings that circular RNAs could potentially predict the development of metabolic disease during pregnancy—which primarily includes gestational diabetes and hypertensive disease of pregnancy—before its onset. "CircRNAs in metabolic disease during pregnancy" (A-138)
• Research showing that changes in the criteria used to diagnose gestational diabetes in pregnant women could eliminate unnecessary confirmatory glucose tolerance testing in 198 patients annually. "Modified fasting glucose cutpoints reduce unnecessary tolerance testing in pregnant women from a large urban and rural population" (A-155)
• A new study investigating how five testing systems for hemoglobin A1c (a biochemical marker used for the management of diabetes) perform in patients who are missing hemoglobin A, the precursor to hemoglobin A1c. "Do samples without HbA have detected HbA1c?" (A-129)

Session Information
AACC Annual Scientific Meeting registration is free for members of the media. Reporters can register online here: https://www.xpressreg.net/register/aacc0716/media/landing.asp

Abstract B-220: Evaluation of GDF-15 and YKL-40 as early markers of subclinical diabetic nephropathy and cardiovascular morbidity in young patients with type 1 diabetes mellitus will be presented during Session 33101: Breakthroughs in Maternal, Fetal, and Pediatric Medicine

Tuesday, August 2
10:30 a.m. – Noon
Room 105AB

Scientific Posters A-129, A-138, and A-155
Tuesday, August 2
9:30 a.m. – 5 p.m. (presenting authors in attendance from 12:30–1:30 p.m.)
Terrace Ballroom

All sessions and scientific posters will be presented at the Pennsylvania Convention Center in Philadelphia.

About the 68^th AACC Annual Scientific Meeting & Clinical Lab Expo
The AACC Annual Scientific Meeting offers 5 days packed with opportunities to learn about exciting science from July 31–August 4. Plenary sessions feature the latest research on the use of and testing for cannabis, combating premature death due to preventable causes such as tobacco and alcohol, the development of an "intelligent" surgical knife, programmable bio-nano-chips, and the epigenetic causes of disease.

At the AACC Clinical Lab Expo, more than 750 exhibitors will fill the show floor of Philadelphia's Pennsylvania Convention Center, with displays of the latest diagnostic technology, including but not limited to mobile health, molecular diagnostics, mass spectrometry, point-of-care, and automation.

About AACC
Dedicated to achieving better health through laboratory medicine, AACC brings together more than 50,000 clinical laboratory professionals, physicians, research scientists, and business leaders from around the world focused on clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of progressing laboratory science. Since 1948, AACC has worked to advance the common interests of the field, providing programs that advance scientific collaboration, knowledge, expertise, and innovation. For more information, visit www.aacc.org.

Christine DeLong
AACC
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AACC
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