Atherosclerosis and Childhood Diabetes – ACD Study
Summary – English
The ACD study follows people with childhood-onset type 1 diabetes, prospectively with follow-up every fifth year, to detect early changes in the heart and blood vessels. The overall aim of the ACD study is to improve early risk detection and develop a tool to guide preventive treatment for cardiovascular disease. The baseline, 5-year, and 10-year follow-up examinations have already been performed, and the 15-year follow-up starts in 2025.
Sammendrag – norsk
ACD-studien følger personer med type 1-diabetes oppstått i barnealder, med undersøkelser hvert 5. år, for å oppdage tidlige forandringer i hjerte og blodårer. ACD-studien har som overordnet mål å bedre tidlig risikovurdering og utvikle et verktøy som kan veilede forebyggende behandling av hjerte- og karsykdommer. Baseline-undersøkelsen samt 5- og 10-års oppfølgingsundersøkelsene er allerede utført, og 15-års oppfølgingen starter i 2025.
Full version
Background: Persons with type 1 diabetes (T1D) have increased mortality due to cardiovascular disease (CVD). More scientific evidence is needed to justify early preventive interventions during childhood and early adulthood. To address this, the ACD study was initiated in 2006.
Aims: To detect early signs of atherosclerosis, follow its progression, and identify predisposing factors in childhood-onset T1D compared to healthy controls. We aim to develop a cardiovascular risk calculator specifically for young people with T1D, to help clinicians and patients decide when to start preventive treatments, such as cholesterol-lowering therapy.
Methods: This is a prospective study with follow-up every 5 years. We measure surrogate markers of atherosclerosis (carotid intima-media thickness, cIMT; inflammatory markers) and a wide range of cardiovascular risk factors, alongside detailed clinical data. Cardiac ultrasound was performed at baseline and a thorough ophthalmologic examination at the 10-year follow-up. During the 15-year follow-up we will perform more advanced diagnostics of atherosclerosis development, in addition to the surrogate markers we have previously measured.
Subjects: At baseline, 324 individuals with T1D aged 8–18 years from one health region in Norway were included, together with 118 healthy controls. 80% of the baseline cohort participated in the 5-year follow-up, with some new participants added. The total cohort now consists of 500 persons, 60% of those participated in the 10-year follow-up.
Progression: The baseline, 5-, and 10-year follow-ups have been completed, showing early-stage atherosclerosis and low-grade inflammation despite short disease duration and intensive insulin treatment, and the 10-year follow-up examinations showed that females with T1D were more affected than males. At the 10-year follow-up, a thorough ophthalmologic examination was performed that revealed that 32% of participants with T1D had early signs of diabetic retinopathy.
News from 2025: The 15-year follow-up has started. All previous participants are invited, including those who missed earlier follow-up rounds and only did the baseline. This follow-up includes advanced cardiovascular imaging — CT coronary angiography, coronary calcium scoring, echocardiography, and vascular ultrasound (carotid and femoral arteries) — as well as comprehensive blood testing, urine albumin-to-creatinine ratio (ACR), blood pressure, and assessment of cardiovascular risk factors. The results will provide new insights into the progression of early vascular changes and improve prediction of CVD risk in young adults with T1D.
Primary Investigator:
Co-investigators during the 15-year follow-up study:
Sverre Grøver Aukrust, MD, Resident in Cardiology (LIS), PhD Fellow, Oslo University Hospital (OUS)
Sigrun Halvorsen, Professor, Department of Cardiology, OUS
Jørgen Gravning, Professor, Department of Cardiology, OUS
Ylva Haig, MD, PhD, Department of Radiology, OUS
Cathrine Brunborg, Department of Biostatistics and Epidemiology, OUS
Ida Gjervold Lunde, Head of Oslo–Center for Clinical Heart Research (Oslo-CCHR) Lab, Professor, OUS
Vibeke Bratseth, Biomedical Laboratory Scientist (BLS), PhD, Oslo–Center for Clinical Heart Research (Oslo-CCHR), OUS
Co-investigators/participants:
Knut Dahl-Jørgensen, Professor emeritus, Oslo Diabetes Research Center, UiO.
Martin Heier, MD, PhD, Pediatric Department, OUS, Ullevål
Aida Simeunovic, Phd student, OUS, Ullevål
Ingebjørg Seljeflot, Professor. Center for Clinical Heart Research, dep of Cardiology, OUS
Cathrine Brunborg, Department of Biostatistics and Epidemiology, OUS
Nina Charlotte Veiby, MD, PhD, Department of Opthalmology, OUS
Goran Petrovski, Professor, Department of Opthalmology, OUS
Mario Garder, sonographer, Norwegian institute of public health
External collaborators:
Torild Skrivarhaug, leader Norwegian Childhood Diabetes Registry, OUS
Kirsten Bjørklund Holven, Department of Nutrition, University of Oslo