Project 454370

Diabetes is the most common cause of kidney failure in Canada, and requires either dialysis or a kidney transplant. Kidney failure leads to persistent unpleasant symptoms that reduce quality of life to levels seen in certain types of advanced cancers. In addition, kidney failure increases the likelihood of cardiovascular disease and premature death. Fortunately, new therapies called "SGLT2 inhibitors" have been discovered that reduce the risk of kidney failure and cardiovascular diseases in people with a kind of diabetes linked with being overweight, called "type 2 diabetes". These drugs may delay the need for dialysis by as much as 15 years, or prevent it entirely. Unfortunately, it is not known if these medicines are also beneficial for people with type 1 diabetes ("juvenile diabetes"), and these medicines are not approved in North America for use in this condition. In our research program, we will perform a series of studies in people with type 1 diabetes. First, we will study kidney effects of SGLT2 inhibition in people with type 1 diabetes over a two year treatment period, including routine blood and urine tests that reflect kidney protection. We will also perform research-based blood and urine tests to understand how these medications may reduce kidney damage over the long term. We will also examine ways to avoid side effects. As part of this study, we will study how patients feel about taking these medications, in terms of both benefits and side effects. Next, we will use Danish health records (where SGLT2 inhibitors can be used for type 1 diabetes) to determine if these therapies reduce the risk of kidney disease when used as part of routine care in type 1 diabetes. Finally, we will study the effectiveness of these medications as a long-term kidney protective therapy using mathematical models. Overall, this program has the potential to reduce the risk of diabetes complications and improve the quality of life in people living with this serious condition.