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Zhang P, Zhang Z, Zhong J, Zheng X, Zhou J, Sun W. Cardiovascular diseases consequences of type 1, type 2 diabetes mellitus and glycemic traits: A Mendelian randomization study. Diabetes Res Clin Pract 2024; 208:111094. [PMID: 38224876 DOI: 10.1016/j.diabres.2024.111094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE This Mendelian randomization (MR) study aimed to investigate the relationships between type 1 diabetes (T1D), type 2 diabetes (T2D), and glycemic traits, including fasting insulin, fasting glucose, and HbA1c, with cardiovascular diseases (CVDs). METHODS We selected genetic instruments for predisposition to T1D, T2D, fasting insulin, fasting glucose, and HbA1c based on published genome-wide association studies. Using a 2-Sample MR approach, we assessed associations with 12 common CVDs sourced from the FinnGen and UK Biobank studies, along with stroke subtypes obtained from the GIGASTROKE and MEGASTROKE Consortium. RESULTS T1D was associated with SVS. T2D showed associations with AIS, LAA, CES, SVS, coronary heart disease, myocardial infarction, pulmonary embolism, DVT of lower extremities, peripheral vascular diseases. Genetically predicted higher HbA1c levels were associated with eight CVDs. The results of MVMR aligned with the primary findings for T1D and T2D. CONCLUSIONS T1D and T2D exhibit different genetic predisposition to CVDs. BMI, LDL, and HDL play intermediary roles in connecting TID and T2D to specific types of CVDs, providing insights into the potential underlying pathways and mechanisms involved in these relationships. Strategies aimed at achieving sustained reductions in HbA1c levels may offer potential for reducing the risk of various CVDs.
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Affiliation(s)
- Pan Zhang
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Zihang Zhang
- Department of Cardiovascular Surgery ICU, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230001, China
| | - Jinghui Zhong
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Xueying Zheng
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), University of Science and Technology of China, Hefei, China
| | - Junling Zhou
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
| | - Wen Sun
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
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Masuda T, Katakami N, Watanabe H, Taya N, Miyashita K, Takahara M, Kato K, Kuroda A, Matsuhisa M, Shimomura I. Evaluation of changes in glycemic control and diabetic complications over time and factors associated with the progression of diabetic complications in Japanese patients with juvenile-onset type 1 diabetes mellitus. J Diabetes 2024; 16:e13486. [PMID: 37853936 PMCID: PMC10859312 DOI: 10.1111/1753-0407.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the changes in glycemic control and diabetic complications over time in Japanese patients with juvenile-onset type 1 diabetes mellitus and to clarify the factors associated with the progression of diabetic complications. METHODS We tracked 129 patients with type 1 diabetes mellitus (21.8 ± 4.1 years old [mean ± SD] with a diabetes duration of 12.6 ± 5.7 years) for up to 19 years and analyzed data on glycated hemoglobin (HbA1c) and indicators related to the severity of diabetic complications (estimated glomerular filtration rate [eGFR], urinary albumin excretion rate [UAE], carotid intima-media thickness [CIMT], and brachial-ankle pulse wave velocity [baPWV]) using linear mixed model and decision tree analysis. RESULTS Although the HbA1c and UAE levels improved over time, the eGFR, CIMT, and baPWV worsened. Decision tree analysis showed that HbA1c and the glycoalbumin/HbA1c ratio for eGFR; HbA1c and systolic blood pressure for UAE; low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, glycoalbumin/HbA1c ratio, and body mass index (BMI) for CIMT; and HbA1c for baPWV were associated factors. CONCLUSIONS In this retrospective observational study, glycemic control and albuminuria improved; however, renal function and arteriosclerosis worsened over time. HbA1c levels, glycemic excursion, and blood pressure are associated with nephropathy progression. HbA1c levels, glycemic excursion, lipid levels, and BMI are associated with the progression of atherosclerosis.
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Affiliation(s)
- Takafumi Masuda
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Naoto Katakami
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hirotaka Watanabe
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Naohiro Taya
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Kazuyuki Miyashita
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Mitsuyoshi Takahara
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
- Department of Diabetes Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Ken Kato
- Diabetes Center, NHO Osaka National HospitalOsakaJapan
| | - Akio Kuroda
- Diabetes Therapeutics and Research CenterInstitute of Advance Medical Sciences, Tokushima UniversityTokushimaJapan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research CenterInstitute of Advance Medical Sciences, Tokushima UniversityTokushimaJapan
| | - Iichiro Shimomura
- Department of Metabolic MedicineOsaka University Graduate School of MedicineOsakaJapan
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Morandi A, Piona C, Corradi M, Marigliano M, Giontella A, Orsi S, Emiliani F, Tagetti A, Marcon D, Fava C, Maffeis C. Risk factors for pre-clinical atherosclerosis in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2023; 198:110618. [PMID: 36906234 DOI: 10.1016/j.diabres.2023.110618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
AIMS To assess whether, besides "traditional" risk factors, overall oxidative stress, oxidized lipoproteins, and glycemic variability are associated with early macro-vascular damage in type 1 diabetes (T1D). METHODS In 267 children/adolescents with T1D (130 girls, age 9.1-23.0 years) we evaluated: derivatives of reactive oxygen metabolites [d-ROMs], serum total antioxidant capacity [TAC] and oxidized LDL-cholesterol [oxLDL]; markers of early vascular damage (Lipoprotein-associated phospholipase A2 [Lp-PLA2], z-score of carotid intima-media thickness [z-cIMT] and carotid-femoral pulse wave velocity [z-PWV]); CGM metrics of four weeks preceding the visit, central systolic/diastolic blood pressures (cSBP/cDBP), and HbA1c, z-score of BP (z-SBP/z-DBP) and circulating lipids longitudinally collected since T1D onset.. Three general linear models were built with z-cIMT, z-PWV adjusted for current cDBP, and Lp-PLA2 as independent variables. RESULTS The z-cIMT was associated with male gender (B = 0.491, η2 = 0.029, p = 0.005), cSBP (B = 0.023, η2 = 0.026, p = 0.008) and oxLDL (B = 0.022, η2 = 0.022, p = 0.014). The z-PWV was associated with diabetes duration (B = 0.054, η2 = 0.024, p = 0.016), daily insulin dose (B = 0.52, η2 = 0.018, p = 0.045), longitudinal z-SBP (B = 0.18, η2 = 0.018, p = 0.045) and dROMs (B = 0.003, η2 = 0.037, p = 0.004). Lp-PLA2 was associated with age (B = 0.221, η2 = 0.079, p = 3*10-6), oxLDL (B = 0.081, η2 = 0.050, p = 2*10-4), longitudinal LDL-cholesterol (B = 0.031, η2 = 0.043, p = 0.001) and male gender (B = -1.62, η2 = 0.10, p = 1.3*107). CONCLUSIONS Oxidative stress, male gender, insulin dose, diabetes duration and longitudinal lipids and blood pressure, contributed to the variance of early vascular damage in young patients with T1D.
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Affiliation(s)
- Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Claudia Piona
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Massimiliano Corradi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alice Giontella
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Verona, Italy
| | - Silvia Orsi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Federica Emiliani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Angela Tagetti
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Verona, Italy
| | - Denise Marcon
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Verona, Italy
| | - Cristiano Fava
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Tran AH, Urbina EM. Is There a Role for Imaging Youth at Risk of Atherosclerosis? Curr Atheroscler Rep 2023; 25:119-126. [PMID: 36848015 DOI: 10.1007/s11883-023-01089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular (CV) risk factors such as dyslipidemia, hypertension, diabetes, and obesity are associated with an increased risk for CV events in adults. Noninvasive measures of vascular health are associated with these CV events and can potentially help risk stratify children with CV risk factors. The purpose of this review is to summarize recent literature regarding vascular health in children with cardiovascular risk factors. RECENT FINDINGS Adverse changes in pulse wave velocity, pulse wave analysis, arterial distensibility, and carotid intima-media thickness are seen in children with CV risk factors supporting potential utility in risk stratification. Assessing vascular health in children can be challenging due to growth-related changes in vasculature, multiple assessment modalities, and differences in normative data. Vascular health assessment in children with cardiovascular risk factors can be a valuable tool for risk stratification and help identify opportunities for early intervention. Future areas of research include increasing normative data, improving conversion of data between different modalities, and increasing longitudinal studies in children linking childhood risk factors to adult CV outcomes.
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Affiliation(s)
- Andrew H Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7002, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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Cielonko LA, Sabati AA, Chambers MA, Newbern D, Swing E, Chakravarthy V, Mullen J, Schmidt J, Lutz N, Shaibi GQ, Olson M. Impact of overweight and obesity on epicardial adipose tissue in children with type 1 diabetes. J Pediatr Endocrinol Metab 2023; 36:371-377. [PMID: 36829271 DOI: 10.1515/jpem-2022-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) thickness, a novel marker of cardiovascular disease (CVD), is increased in children with a healthy weight and type 1 diabetes (T1D). The prevalence of obesity has increased in children with T1D and may confer additional CVD risk. The purpose of this study was to examine EAT thickness in youth with and without T1D in the setting of overweight/obesity. METHODS Youth with overweight/obesity and T1D (n=38) or without T1D (n=34) between the ages of 6-18 years were included in this study. Echocardiogram using spectral and color flow Doppler was used to measure EAT and cardiac function. Waist circumference, blood pressure, and HbA1c, were used to calculate estimated glucose disposal rate (eGDR) to estimate insulin resistance in children with T1D. RESULTS EAT thickness was not significantly different in youth with T1D compared to controls (2.10 ± 0.67 mm vs. 1.90 ± 0.59 mm, p=0.19). When groups were combined, EAT significantly correlated with age (r=0.449, p≤0.001), BMI (r=0.538, p≤0.001), waist circumference (r=0.552, p≤0.001), systolic BP (r=0.247, p=0.036), myocardial performance index (r=-0.287, p=0.015), ejection fraction (r=-0.442, p≤0.001), and cardiac output index (r=-0.306, p=0.009). In the group with T1D, diastolic BP (r=0.39, p=0.02) and eGDR (r=-0.48, p=0.002) correlated with EAT. CONCLUSIONS EAT was associated with measures of adiposity and insulin resistance but does not differ by diabetes status among youth with overweight/obesity. These findings suggest that adiposity rather than glycemia is the main driver of EAT thickness among youth with T1D.
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Affiliation(s)
- Luke A Cielonko
- Division of Endocrinology, Cook Children's Medical Center, Fort Worth, TX, USA
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Arash A Sabati
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Melissa A Chambers
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dorothee Newbern
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Edward Swing
- Division of Graduate Medical Education, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Varshini Chakravarthy
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - John Mullen
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Jaclyn Schmidt
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Natalie Lutz
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Micah Olson
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
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Karamanakos G, Barmpagianni A, Kapelios CJ, Kountouri A, Bonou M, Makrilakis K, Lambadiari V, Barbetseas J, Liatis S. The association of insulin resistance measured through the estimated glucose disposal rate with predictors of micro-and macrovascular complications in patients with type 1 diabetes. Prim Care Diabetes 2022; 16:837-843. [PMID: 36272914 DOI: 10.1016/j.pcd.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Insulin resistance (IR) is associated with a higher rate of type 1 diabetes (T1D) complications. We aimed to examine the relationship between estimated glucose disposal rate (eGDR), a readily available marker of IR in clinical practice and early predictor biomarkers of macrovascular and microvascular complications in patients with T1D. DESIGN A cross-sectional study. METHODS A total of 165 consecutive patients with T1D free of cardiovascular, eye, and renal complications were included in the study from 2016 to 2020. Participants were characterized as insulin resistant if their eGDR value was ≤ 8 mg/kg/min. Pulse wave velocity (PWV) and global longitudinal strain (GLS) were used as surrogates for subclinical atherosclerosis and left ventricular systolic dysfunction (LVSD), respectively. Four previously standardized tests based on the calculation of heart rate variability (HRV) were used to evaluate subclinical cardiac autonomic neuropathy (CAN). Early nephropathy was assessed by assessing urinary albumin to creatinine ratio (ACR). RESULTS The population sample (n = 165) included a majority of female patients (63%) and had a median age of 32 years (24-43), median disease duration of 14 years ( ± 9.5-21.5), a median BMI value of 23.7 kg/m2 (21.4-26.6), an HbA1C of 7.2% (6.7-8.2) and median eGDR (lower values indicate higher insulin resistance) of 9.2 mg/kg/min (8.2-9.9), while 21.8% (n = 36) of the participants were characterized as insulin resistant. After adjustment for age, gender, and the duration of diabetes, the presence of IR was significantly associated with higher prevalence of subclinical atherosclerosis (OR:2.59, 95% CI: 1.06-6.30, p = 0.036), CAN (OR:3.07, 95% CI: 1.02-9.32, p = 0.047) and subclinical LVSD (OR: 4.9, 95% CI: 1.94-12.79, p = 0.001). No association was shown with ACR. CONCLUSIONS In patients with T1D, insulin resistance, as measured by eGDR, correlates well with early CVD predictors and CAN. These associations appear independent of the effects of gender, aging, and disease duration.
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Affiliation(s)
- Georgios Karamanakos
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Aikaterini Barmpagianni
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos J Kapelios
- Department of Health Policy, London School of Economics and Political Science, London, UK; Cardiology Department, Laiko General Hospital, Athens, Greece, London School of Economics and Political Science, London, UK
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Propaedeutic and Research Institute, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - Maria Bonou
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Propaedeutic and Research Institute, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - John Barbetseas
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Shah AS, Isom S, D’Agostino R, Dolan LM, Dabelea D, Imperatore G, Mottl A, Lustigova E, Pihoker C, Marcovina S, Urbina EM. Longitudinal Changes in Arterial Stiffness and Heart Rate Variability in Youth-Onset Type 1 Versus Type 2 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2022; 45:1647-1656. [PMID: 35667385 PMCID: PMC9274217 DOI: 10.2337/dc21-2426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We compared arterial stiffness and heart rate variability (HRV) over time by diabetes type and determined the risk factors associated with worsening arterial stiffness and HRV in young adults with youth-onset diabetes. RESEARCH DESIGN AND METHODS Arterial stiffness (pulse wave velocity, augmentation index) and six indices of heart rate variability were measured twice, 4.5 years apart, among participants with either youth-onset type 1 or type 2 diabetes in the SEARCH for Diabetes in Youth study. Multivariable linear regression models were used to assess risk factors associated with arterial stiffness and HRV at follow-up. RESULTS Of 1,159 participants studied, 949 had type 1 diabetes (mean age 17.1 ± 4.7 years, 60.3% non-Hispanic White, 55% female) and 210 had type 2 diabetes (mean age 22.1 ± 3.5 years, 23.8% non-Hispanic White, 71% female) at initial assessment when diabetes duration was 7.9 years (both groups). Participants with type 2 versus type 1 diabetes had greater arterial stiffness and more abnormalities in HRV at initial and follow-up assessment and a greater change over time (all P < 0.05). Risk factors associated with worse arterial stiffness and HRV at follow-up in both types of diabetes included higher blood pressure, hemoglobin A1c, waist circumference, and triglycerides over time and longer diabetes duration. CONCLUSIONS Arterial stiffness and HRV worsened over time with greater changes among participants with type 2 versus type 1 diabetes and among those with features of the metabolic syndrome. The risk factor profile documents potentially modifiable pathways to prevent or limit cardiovascular complications in young adults with youth-onset diabetes.
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Affiliation(s)
- Amy S. Shah
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph D’Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lawrence M. Dolan
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amy Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Eva Lustigova
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | | | - Elaine M. Urbina
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
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Love KM, Horton WB, Patrie JT, Jahn LA, Hartline LM, Barrett EJ. Predictors of arterial stiffness in adolescents and adults with type 1 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 2022; 10:e002491. [PMID: 34987053 PMCID: PMC8734015 DOI: 10.1136/bmjdrc-2021-002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Individuals with type 1 diabetes have increased arterial stiffness compared with age-matched healthy controls. Our aim was to determine which hemodynamic and demographic factors predict arterial stiffness in this population. RESEARCH DESIGN AND METHODS Carotid-femoral pulse wave velocity (cfPWV) was examined in 41 young adults and adolescents with type 1 diabetes without microvascular complications. Two ordinary least squares regression analyses were performed to determine multivariate relationships between cfPWV (loge) and (1) age, duration of diabetes, sex, and hemoglobin A1c and (2) augmentation index (AIx), mean arterial pressure, flow-mediated dilation (FMD), and heart rate. We also examined differences in macrovascular outcome measures between sexes. RESULTS Age, sex, and FMD provided unique predictive information about cfPWV in these participants with type 1 diabetes. Despite having similar cardiovascular risk factors, men had higher cfPWV compared with women but no differences were observed in other macrovascular outcomes (including FMD and AIx). CONCLUSIONS Only age, sex, and FMD were uniquely associated with arterial stiffness in adolescents and adults with uncomplicated type 1 diabetes. Women had less arterial stiffness and similar nitric oxide-dependent endothelial function compared with men. Larger, prospective investigation is warranted to determine the temporal order of and sex differences in arterial dysfunction in type 1 diabetes.
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Affiliation(s)
- Kaitlin M Love
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - William B Horton
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Linda A Jahn
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lee M Hartline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eugene J Barrett
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Pharmacology, University of Virginia Health System, Charlottesville, Virginia, USA
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Kulecki M, Uruska A, Naskret D, Zozulinska-Ziolkiewicz D. Arterial Stiffness and Type 1 Diabetes: The Current State of Knowledge. Curr Diabetes Rev 2022; 18:e140621194054. [PMID: 35546329 DOI: 10.2174/1573399817666210614113827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
The most common cause of mortality among people with type 1 diabetes is cardiovascular diseases. Arterial stiffness allows predicting cardiovascular complications, cardiovascular mortality, and all-cause mortality. There are different ways to measure arterial stiffness; the gold standard is pulse wave velocity. Arterial stiffness is increased in people with type 1 diabetes compared to healthy controls. It increases with age and duration of type 1 diabetes. Arterial stiffness among people with type 1 diabetes positively correlates with systolic blood pressure, obesity, glycated hemoglobin, waist circumference, and waist to hip ratio. It has a negative correlation with the estimated glomerular filtration rate, high-density lipoprotein, and the absence of carotid plaques. The increased arterial stiffness could result from insulin resistance, collagen increase due to inadequate enzymatic glycation, and endothelial and autonomic dysfunction. The insulin-induced decrease in arterial stiffness is impaired in type 1 diabetes. There are not enough proofs to use pharmacotherapy in the prevention of arterial stiffness, but some of the medicaments got promising results in single studies, for example, renin-angiotensin-aldosterone system inhibitors, statins, and SGLT2 inhibitors. The main strategy of prevention of arterial stiffness progression remains glycemic control and a healthy lifestyle.
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Affiliation(s)
- Michal Kulecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
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March CA, Becker DJ, Libman IM. Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications. Front Endocrinol (Lausanne) 2021; 12:622901. [PMID: 33828529 PMCID: PMC8021094 DOI: 10.3389/fendo.2021.622901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of "double diabetes". The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.
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11
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Chiesa ST, Marcovecchio ML, Benitez-Aguirre P, Cameron FJ, Craig ME, Couper JJ, Davis EA, Dalton RN, Daneman D, Donaghue KC, Jones TW, Mahmud FH, Marshall SM, Neil HAW, Dunger DB, Deanfield JE. Vascular Effects of ACE (Angiotensin-Converting Enzyme) Inhibitors and Statins in Adolescents With Type 1 Diabetes. Hypertension 2020; 76:1734-1743. [PMID: 33100044 DOI: 10.1161/hypertensionaha.120.15721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An increased albumin-creatinine ratio within the normal range can identify adolescents at higher risk of developing adverse cardio-renal outcomes as they progress into adulthood. Utilizing a parallel randomized controlled trial and observational cohort study, we characterized the progression of vascular phenotypes throughout this important period and investigated the effect of ACE (angiotensin-converting enzyme) inhibitors and statins in high-risk adolescents. Endothelial function (flow-mediated dilation and reactive hyperemia index) and arterial stiffness (carotid-femoral pulse wave velocity) were assessed in 158 high-risk participants recruited to a randomized, double-blind placebo-controlled 2×2 factorial trial (randomized, placebo-controlled trial) of ACE inhibitors and/or statins in adolescents with type 1 diabetes (AdDIT [Adolescent Type 1 Diabetes cardio-renal Intervention Trial]). Identical measures were also assessed in 215 lower-risk individuals recruited to a parallel observational study. In the randomized, placebo-controlled trial, high-risk patients randomized to ACE inhibitors had improved flow-mediated dilation after 2 to 4 years of follow-up (mean [95% CI]: 6.6% [6.0-7.2] versus 5.3% [4.7-5.9]; P=0.005), whereas no effect was observed following statin use (6.2% [5.5-6.8] versus 5.8% [5.1-6.4]; P=0.358). In the observational study, patients classed as high-risk based on albumin-creatinine ratio showed evidence of endothelial dysfunction at the end of follow-up (flow-mediated dilation=4.8% [3.8-5.9] versus 6.3% [5.8-6.7] for high-risk versus low-risk groups; P=0.015). Neither reactive hyperemia index nor pulse wave velocity were affected by either treatment (P>0.05 for both), but both were found to increase over the duration of follow-up (0.07 [0.03-0.12]; P=0.001 and 0.5 m/s [0.4-0.6]; P<0.001 for reactive hyperemia index and pulse wave velocity, respectively). ACE inhibitors improve endothelial function in high-risk adolescents as they transition through puberty. The longer-term protective effects of this intervention at this early age remain to be determined. Registration- URL: https://www.clinicaltrials.gov; Unique identifier NCT01581476.
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Affiliation(s)
- Scott T Chiesa
- From the Institute of Cardiovascular Science, University College London, United Kingdom (S.T.C., J.E.D.)
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Camperdown, Australia (P.B.-A., K.C.D.)
| | - Fergus J Cameron
- Department of Paediatrics, University of Melbourne, Australia (F.J.C.)
| | - Maria E Craig
- School of Women's and Children's Health, University of New South Wales, Australia (M.E.C.)
| | - Jennifer J Couper
- Departments of Endocrinology and Diabetes, Women's and Children's Hospital, Robinson Research Institute, University of Adelaide, Australia (J.J.C.)
| | - Elizabeth A Davis
- Telethon Kids Institute, University of Western Australia, Perth (E.A.D., T.W.J.)
| | - R Neil Dalton
- Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom (R.N.D.)
| | - Denis Daneman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada (D.D., F.H.M.)
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Camperdown, Australia (P.B.-A., K.C.D.)
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth (E.A.D., T.W.J.)
| | - Farid H Mahmud
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada (D.D., F.H.M.)
| | - Sally M Marshall
- Institute of Cellular Medicine (Diabetes), Faculty of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (S.M.M.)
| | - H Andrew W Neil
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, United Kingdom (H.A.W.N.)
| | - David B Dunger
- Department of Paediatrics (M.L.M., D.B.D.), University of Cambridge, United Kingdom.,Wellcome Trust-MRC Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom
| | - John E Deanfield
- From the Institute of Cardiovascular Science, University College London, United Kingdom (S.T.C., J.E.D.)
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12
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Schäfer M, Nadeau KJ, Reusch JEB. Cardiovascular disease in young People with Type 1 Diabetes: Search for Cardiovascular Biomarkers. J Diabetes Complications 2020; 34:107651. [PMID: 32546422 PMCID: PMC7585936 DOI: 10.1016/j.jdiacomp.2020.107651] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
Premature onset of cardiovascular disease is common in people with type 1 diabetes and is relatively understudied in youth. Several reports in adolescents and young adults with diabetes demonstrate evidence of arterial stiffness and cardiac dysfunction, yet critical gaps exist in our current understanding of the temporal progression of cardiac and vascular dysfunction in these youth, and mechanistic investigations with robust pathophysiologic assessment are lacking. This review attempts to summarize relevant cardiovascular studies concerning children, adolescents, and young adults with type 1 diabetes. We focus on imaging-based biomarkers routinely applied to youth and adults that are well-established in their ability to predict adjudicated cardiovascular outcomes, and their relevant physiologic interpretation. Particularly, we focus the attention to 1) cardiac ventricular strain imaging techniques which are known to be predictive of clinical outcomes in patients with heterogenous causes of heart failure, and 2) stiffness in large arteries, a well-established prognostic marker of cardiovascular events. We conclude that there remains an urgent need for sensitive and quantitative biomarkers to define the natural history of cardiac and vascular disease origination and progression in type 1 diabetes, and set the stage for interpreting interventional studies focused on preventing, reversing or slowing disease progression.
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Affiliation(s)
- Michal Schäfer
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado - School of Medicine, Aurora, CO, United States of America.
| | - Kristen J Nadeau
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado - School of Medicine, Aurora, CO, United States of America
| | - Jane E B Reusch
- Section of Endocrinology, Rocky Mountain Regional VAMC, CO, United States of America; Division of Endocrinology, Department of Medicine, United States of America; Center for Women's Health Research, University of Colorado - School of Medicine, Aurora, CO, United States of America
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13
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Pulkkinen MA, Tuomaala AK, Hero M, Gordin D, Sarkola T. Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e001216. [PMID: 32723754 PMCID: PMC7388880 DOI: 10.1136/bmjdrc-2020-001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. RESULTS 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. CONCLUSION There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk. TRIAL REGISTRATION NUMBER NCT02637154.
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Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Hero
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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14
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Błaszkowska M, Shalimova A, Wolnik B, Orłowska-Kunikowska E, Graff B, Hoffmann M, Nilsson P, Wolf J, Narkiewicz K. Subclinical macroangiopathic target organ damage in type 1 diabetes mellitus patients. Blood Press 2020; 29:344-356. [PMID: 32460564 DOI: 10.1080/08037051.2020.1770054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE We have summarized key studies regarding the assessment of subclinical macroangiopathic target organ damage (TOD) in type 1 diabetes mellitus (T1DM). RESULTS Although chronic complications resulting from hyperglycemia, in particular macroangiopathies, are still the first cause of death in T1DM, there has been growing recognition of the role of hypoglycemia in cardiovascular morbidity and mortality. Subclinical TOD diagnosis ensures early implementation of the complex management aiming at either partial reversal of these complications or at least its downturn. To better identify patients with early TODs, several non-invasive diagnostic techniques are employed, including the ultrasonographic assessment of the intima-media thickness (IMT), computed tomography (CT) for coronary artery calcium (CAC) scores, and pulse wave velocity (PWV) measurement for arterial stiffness evaluation. Various studies reported that T1DM patients present an increased IMT. An increasing IMT fairly correlates with the cardiovascular (CV) events risk even after the adjustment to age, diabetes duration, quality of glucose control as well as the presence of hypertension, and chronic complications. Another, well established marker of the organ damage - CAC score is recommended by ACC/AHA guidelines to assess the overall CV risk in T1DM. Also, the arterial stiffness evaluation with PWV may further improve CV risk prediction, which has been reported in multiple studies including the Framingham Heart Study. CONCLUSIONS There is shortage of data from prospective studies which could confirm the benefits of early treatment initiation based on the presence of the subclinical organ damage in T1DM. Most evidence comes from T2DM trials, where effective preventive measures were identified i.e.: smoking cessation, reasonable blood glucose control, efficacious hypertension treatment, and dyslipidemia management, as well as renoprotection. There is still a field for further research to see if routine assessment of asymptomatic vascular damage and early implementation of aggressive treatment would reduce mortality excess from CVD in T1DM.
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Affiliation(s)
- Magdalena Błaszkowska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland
| | - Anna Shalimova
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland.,Department of Internal Medicine N1, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland
| | | | - Beata Graff
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland
| | - Michał Hoffmann
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Faculty of Medicine, Gdansk, Poland
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15
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Davis CL, Litwin SE, Pollock NK, Waller JL, Zhu H, Dong Y, Kapuku G, Bhagatwala J, Harris RA, Looney J, Williams CF, Armento A, Schmidt MD, Bassali R. Exercise effects on arterial stiffness and heart health in children with excess weight: The SMART RCT. Int J Obes (Lond) 2020; 44:1152-1163. [PMID: 31754238 PMCID: PMC7192762 DOI: 10.1038/s41366-019-0482-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/14/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Childhood obesity and inactivity are associated with cardiovascular risk. Evidence is limited for exercise effects on arterial health in children. METHODS One hundred and seventy-five inactive children with overweight or obesity (8-11 years, ≥85th percentile BMI, 61% female, 87% Black, 73% with obesity) were randomized to an 8-month daily after-school aerobic exercise program (40 min/day, n = 90) or a sedentary control condition (n = 85). Carotid-femoral pulse wave velocity (PWV, primary outcome, arterial stiffness), fitness, adiposity, blood pressure (BP), glucose, insulin resistance, lipids, and C-reactive protein were measured at baseline and posttest (8 months). Adiposity, fitness, and BP were measured again at follow-up, 8-12 months later. Intent-to-treat analyses were conducted using mixed models. RESULTS The study had 89% retention, with attendance of 59% in exercise and 64% in the control condition, and vigorous exercise participation (average heart rate 161 ± 7 beats/min). Compared with controls, the exercise group had twice the improvement in fitness (VȮ2 peak, 2.7 (95% CI 1.8, 3.6) vs. 1.3 (0.4, 2.3) mL/kg/min) and adiposity (-1.8 (-2.4, -1.1) vs. -0.8 (-1.5, -0.1)%), each p = 0.04, and a large improvement in HDL-cholesterol (0.13 (0.075, 0.186) vs. -0.028 (-0.083, 0.023) mmol/L, p < 0.0001). There was no group × time effect on other outcomes at 8 months, or on any outcomes at follow-up. The change in PWV at 8 months correlated with changes in insulin and insulin resistance (both r = 0.32), diastolic BP (r = 0.24), BMI (r = 0.22), and adiposity (r = 0.18). CONCLUSIONS Eight months of aerobic exercise training improved fitness, adiposity, and HDL-cholesterol levels, but did not reduce arterial stiffness in children with excess weight. PWV improved as a function of insulin resistance, BP, BMI, and adiposity. Weight loss may be required to improve arterial stiffness. Exercise benefits waned after discontinuing the program.
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Affiliation(s)
- Catherine L Davis
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA.
- Medicine, MCG, Augusta University, Augusta, GA, USA.
| | - Sheldon E Litwin
- Cardiology, Medicine, MCG, Augusta University, Augusta, GA, USA
- Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Norman K Pollock
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Jennifer L Waller
- Population Health Sciences, MCG, Augusta University, Augusta, GA, USA
| | - Haidong Zhu
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Gaston Kapuku
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Jigar Bhagatwala
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Ryan A Harris
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Jacob Looney
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Celestine F Williams
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Aubrey Armento
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | | | - Reda Bassali
- Pediatrics, MCG, Augusta University, Augusta, GA, USA
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16
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Gourgari E, Stafford JM, D'Agostino Jr R, Dolan LM, Lawrence JM, Mottl A, Pihoker C, Urbina EM, Wadwa RP, Dabelea D. Association of metformin and statin medications with surrogate measures of cardiovascular disease in youth with type 1 diabetes: the SEARCH for diabetes in youth study. Ann Pediatr Endocrinol Metab 2019; 24:187-194. [PMID: 31607112 PMCID: PMC6790871 DOI: 10.6065/apem.2019.24.3.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/04/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Youth with type 1 diabetes mellitus (T1DM) are at risk of cardiovascular disease (CVD). We evaluated if metformin or statin use was associated with surrogate measures of improved CVD. METHODS We included participants from the SEARCH observational study. Participants treated with insulin plus metformin (n=42) or insulin plus statin (n=39) were matched with 84 and 78 participants, respectively, treated with insulin alone. Measures of arterial stiffness obtained were pulse wave velocity (PWV), augmentation index (AI75), and heart rate variability as standard deviation of the normal-to-normal interval (SDNN) and root mean square differences of successive NN intervals (RMSSD). RESULTS CVD measures were not significantly different among participants on insulin plus metformin versus those on insulin alone: PWV (5.9±1.0 m/sec vs. 5.8±1.5 m/sec, P=0.730), AI75 (1.8 [-6.0 to 8.0] vs. -2.4 [-10.7 to 3.8], P=0.157), SDNN (52.4 [36.8-71.1] m/sec vs. 51.8 [40.1-74.9] m/sec, P=0.592), and RMSSD (43.2 [29.4-67.6] vs. 47.4 [28.0-76.3], P=0.952). CVD measures were not different for statin users versus nonusers: PWV (5.7±0.8 m/sec vs. 5.9 ±1.1 m/sec, P=0.184), AI75 ( -4.0 [-9.5 to 1.7] vs. -6.7 [-11.3 to 5.7], P=0.998), SDNN (54.6 [43.5-77.2] m/sec vs. 63.1 [44.2-86.6] m/sec, P=0.369), and RMSSD (49.5 [31.2-74.8] vs. 59.2 [38.3-86.3], P=0.430). CONCLUSION We found no associations of statin or metformin use with surrogate measures of CVD. Future prospective pediatric clinical trials could address this issue.
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Affiliation(s)
- Evgenia Gourgari
- Division of Pediatric Endocrinology, Department of Pediatrics, Georgetown University, Washington, DC, USA,Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD, USA,Address for correspondence: Evgenia Gourgari, MD Division of Pediatric Endocrinology, MedStar Georgetown University Hospital, 4200 Wisconsin Avenue, N.W, 4th Floor, Washington, D.C. 20016, USA Tel: +1-202-243-3560 Fax: +1-877-680-5507 E-mail:
| | - Jeanette M. Stafford
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ralph D'Agostino Jr
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lawrence M. Dolan
- Department of Pediatrics, Cincinnati Children's Hospital and the University of Cincinnati, Cincinnati, OH, USA
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Amy Mottl
- UNC Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Elaine M. Urbina
- Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, OH, USA
| | - R. Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
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17
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Adeva-Andany MM, Funcasta-Calderón R, Fernández-Fernández C, Ameneiros-Rodríguez E, Domínguez-Montero A. Subclinical vascular disease in patients with diabetes is associated with insulin resistance. Diabetes Metab Syndr 2019; 13:2198-2206. [PMID: 31235157 DOI: 10.1016/j.dsx.2019.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/22/2019] [Indexed: 12/30/2022]
Abstract
Patients with diabetes experience increased cardiovascular risk that is not fully explained by deficient glycemic control or traditional cardiovascular risk factors such as smoking and hypercholesterolemia. Asymptomatic patients with diabetes show structural and functional vascular damage that includes impaired vasodilation, arterial stiffness, increased intima-media thickness and calcification of the arterial wall. Subclinical vascular injury associated with diabetes predicts subsequent manifestations of cardiovascular disease, such as ischemic heart disease, peripheral artery disease and stroke. Noninvasive detection of subclinical vascular disease is commonly used to estimate cardiovascular risk associated to diabetes. Longitudinal studies in normotensive subjects show that arterial stiffness at baseline is associated with a greater risk for future hypertension independently of established risk factors. In patients with type 2 diabetes, vascular disease begins to develop during the latent phase of insulin resistance, long before the clinical diagnosis of diabetes. In contrast, patients with type 1 diabetes do not manifest vascular injury when they are first diagnosed due to insulin deficiency, as they lack the preceding period of insulin resistance. These findings suggest that insulin resistance plays an important role in the development of early vascular disease associated with diabetes. Cross-sectional and prospective studies confirm that insulin resistance is associated with subclinical vascular injury in patients with diabetes, independently of standard cardiovascular risk factors. Asymptomatic vascular disease associated with diabetes begins to occur early in life having been documented in children and adolescents. Insulin resistance should be considered a therapeutic target in order to prevent the vascular complications associated with diabetes.
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Affiliation(s)
- María M Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, C/ Pardo Bazán S/n, 15406, Ferrol, Spain.
| | - Raquel Funcasta-Calderón
- Internal Medicine Department, Hospital General Juan Cardona, C/ Pardo Bazán S/n, 15406, Ferrol, Spain
| | | | - Eva Ameneiros-Rodríguez
- Internal Medicine Department, Hospital General Juan Cardona, C/ Pardo Bazán S/n, 15406, Ferrol, Spain
| | - Alberto Domínguez-Montero
- Internal Medicine Department, Hospital General Juan Cardona, C/ Pardo Bazán S/n, 15406, Ferrol, Spain
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18
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Adeva-Andany MM, Martínez-Rodríguez J, González-Lucán M, Fernández-Fernández C, Castro-Quintela E. Insulin resistance is a cardiovascular risk factor in humans. Diabetes Metab Syndr 2019; 13:1449-1455. [PMID: 31336505 DOI: 10.1016/j.dsx.2019.02.023] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 01/08/2023]
Abstract
Diabetes is a common metabolic disorder associated to elevated cardiovascular morbidity and mortality that is not explained by hyperglycemia or traditional cardiovascular risk factors such as smoking or hypercholesterolemia. Intensive glycemic control with insulin that achieves near-normal glycemia does not reduce significantly macrovascular complications compared with conventional glycemic control. Cardiovascular disease continues to develop in patients with diabetes despite adequate glycemic control. In contrast, intensive control with metformin (leading to insulin resistance improvement) reduces diabetes complications, including cardiovascular events, suggesting that enhancement of insulin sensitivity rather than plasma glucose level has a major role improving diabetes outcomes. Accordingly, insulin resistance estimated by glucose tolerance tests is better predictor of future cardiovascular events than fasting glucose level in nondiabetic individuals. Insulin resistance precedes for decades the clinical onset of type 2 diabetes and deteriorates metabolic control of type 1 diabetes. Numerous investigations including cross-sectional and prospective studies, meta-analyses, and systematic reviews provide compelling evidence that insulin resistance by itself is a cardiovascular risk factor in a variety of population groups, including the general population and patients with diabetes. Several estimations of insulin resistance have been consistently associated with elevated rate of cardiovascular events independently of other cardiovascular risk factors and diabetes status. The clinical expression of insulin resistance (the metabolic syndrome or any of its components including obesity, hyperinsulinemia, hypertension, and dyslipemia) has been related to cardiovascular disease as well. An estimation conducted by the Archimedes model confirms that insulin resistance is the most important single cause of coronary artery disease.
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Affiliation(s)
- María M Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406, Ferrol, Spain.
| | - Julia Martínez-Rodríguez
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406, Ferrol, Spain
| | - Manuel González-Lucán
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406, Ferrol, Spain
| | | | - Elvira Castro-Quintela
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406, Ferrol, Spain
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Cree-Green M, Stuppy JJ, Thurston J, Bergman BC, Coe GV, Baumgartner AD, Bacon S, Scherzinger A, Pyle L, Nadeau KJ. Youth With Type 1 Diabetes Have Adipose, Hepatic, and Peripheral Insulin Resistance. J Clin Endocrinol Metab 2018; 103:3647-3657. [PMID: 30020457 PMCID: PMC6179173 DOI: 10.1210/jc.2018-00433] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Adolescents with type 1 diabetes (T1D) have difficulty obtaining optimal glucose control, which may relate to insulin resistance (IR), especially during puberty. Moreover, IR increases the risk for cardiovascular disease, the leading cause of death in T1D. However, the tissue specificity of IR in adolescents with T1D has not been fully phenotyped. OBJECTIVE To assess adipose, hepatic, and peripheral insulin sensitivity in adolescents with and without T1D. DESIGN AND SETTING Thirty-five youth with T1D [median age, 16 (first and third quartiles, 14, 17) years; 53% female; median body mass index (BMI) percentile, 82nd (55th, 96th); late puberty; median hemoglobin A1c, 8.3% (7.3%, 9.4%)] and 22 nondiabetic youth of similar age, BMI, pubertal stage, and level of habitual physical activity were enrolled. Insulin action was measured with a four-phase hyperinsulinemic euglycemic clamp (basal and 10, 16, and 80 mU/m2/min) with glucose and glycerol isotope tracers. RESULTS Adolescents with T1D had a significantly higher rate of lipolysis (P < 0.0001) and endogenous glucose production (P < 0.001) and lower peripheral glucose uptake (glucose rate of disappearance, 6.9 ± 2.9 mg/kg/min for patients with T1D vs 11.3 ± 3.3 for controls; P < 0.0001) during hyperinsulinemia compared with controls. In youth with T1D, glucose rate of disappearance correlated with free fatty acid at the 80-mU/m2/min phase (P = 0.005), markers of inflammation (IL-6; P = 0.012), high-sensitivity C-reactive protein (P = 0.001), and leptin (P = 0.008)], but not hemoglobin A1c. CONCLUSIONS Adolescents with T1D have adipose, hepatic and peripheral IR. This IR occurs regardless of obesity and metabolic syndrome features. Youth with T1D may benefit from interventions directed at improving IR in these tissues, and this area requires further research.
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Affiliation(s)
- Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Correspondence and Reprint Requests: Melanie Cree-Green, MD, PhD, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, P.O. Box 265, 13123 East 16th Avenue, Aurora, Colorado 80045. E-mail:
| | - Jacob J Stuppy
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Biomedical Sciences and Biotechnology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica Thurston
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Bryan C Bergman
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gregory V Coe
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amy D Baumgartner
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samantha Bacon
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ann Scherzinger
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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20
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Stawiski K, Pietrzak I, Młynarski W, Fendler W, Szadkowska A. NIRCa: An artificial neural network-based insulin resistance calculator. Pediatr Diabetes 2018. [PMID: 28626972 DOI: 10.1111/pedi.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Direct measurement of insulin sensitivity in children with type 1 diabetes is cumbersome and time consuming. OBJECTIVE The aim of our study was to develop novel, accurate machine learning-based methods of insulin resistance estimation in children with type 1 diabetes. METHODS A hyperinsulinemic hyperglycemic clamp study was performed to evaluate the glucose disposal rate (GDR) in a study group consisting of 315 patients aged 7.6 to 19.7 years. The group was randomly divided into a training and independent testing set for model performance assessment. GDR was estimated on the basis of simple clinical variables using 2 non-linear methods: artificial neural networks (ANN) and multivariate adaptive regression splines (MARSplines). The results were compared against the most frequently used predictive model, based on waist circumference, triglyceride (TG), and HbA1c levels. RESULTS The reference model showed moderate performance ( R 2 = 0.26) with a median absolute percentage error of 49.1%, and with the worst fit observed in young (7-12 years) children ( R 2 = 0.17). Predictions of the MARSplines model were significantly more accurate than those of the reference model (median error 3.6%, R 2 = 0.44 P < .0001). The predictions of the ANN, however, showed significantly lower error than those of the reference model (P < .0001) and MARSplines (P < .0001) and better fit regardless of patient age. ANN-estimated GDRs were within a ±20% error range in 75% of cases with a median error of 0.6% and an R 2 = 0.66. The predictive tool is available at http://link.konsta.com.pl/gdr. CONCLUSIONS The developed GDR estimation model reliant on ANN allows for an optimized prediction of GDR for research and clinical purposes.
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Affiliation(s)
- Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Iwona Pietrzak
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.,Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
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Gourgari E, Dabelea D, Rother K. Modifiable Risk Factors for Cardiovascular Disease in Children with Type 1 Diabetes: Can Early Intervention Prevent Future Cardiovascular Events? Curr Diab Rep 2017; 17:134. [PMID: 29101482 PMCID: PMC5670186 DOI: 10.1007/s11892-017-0968-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Patients with type 1 diabetes have increased risk for cardiovascular disease. The purpose of this review is to examine the following: i) current evidence for subclinical cardiovascular disease (CVD) in children with type 1 diabetes (T1DM) ii) known modifiable risk factors for CVD and their relationship to subclinical CVD in this population iii) studies that have addressed these risk factors in order to improve CVD outcomes in children with T1DM RECENT FINDINGS: Subclinical CVD presents in children as increased carotid intima-media thickness, increased arterial stiffness, and endothelial and myocardial dysfunction. Modifiable risk factors for CVD include hyperglycemia, hyperlipidemia, obesity, hypertension, depression, and autonomic dysfunction. Very few randomized controlled studies have been done in children with T1DM to examine how modification of these risk factors can affect their CVD. Children with T1DM have subclinical CVD and multiple modifiable risk factors for CVD. More research is needed to define how modification of these factors affects the progression of CVD.
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Affiliation(s)
- Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington DC, USA
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO USA
| | - Kristina Rother
- Section on Pediatric Diabetes and Metabolism, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD USA
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Ryan TD, Parent JJ, Gao Z, Khoury PR, Dupont E, Smith JN, Wong B, Urbina EM, Jefferies JL. Central Arterial Function Measured by Non-invasive Pulse Wave Analysis is Abnormal in Patients with Duchenne Muscular Dystrophy. Pediatr Cardiol 2017. [PMID: 28639151 DOI: 10.1007/s00246-017-1657-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder caused by mutation of dystrophin. Cardiovascular involvement includes dilated cardiomyopathy. Non-invasive assessment of vascular function has not been evaluated in DMD. We hypothesize arterial wave reflection is abnormal in patients with DMD. Pulse wave analysis was performed on DMD patients with a SphygmoCor SCOR-PVx System to determine central blood pressure and augmentation index (AIx) as an assessment of arterial wave reflection. Results were compared to a control group. A total of 43 patients with DMD were enrolled, and compared to 43 normal controls. Central systolic blood pressure was lower, while both AIx-75 (7.8 ± 9.6% vs. 2.1 ± 10.4%, p 0.01, DMD vs. normal) and AIx-not corrected (16.8 ± 10.1% vs. -3.6 ± 10.9, p < 0.001, DMD vs. normal) were higher in the DMD compared to control. Using multivariable linear regression model, the variables found to have a significant effect on AIx-not corrected included diagnosis of DMD, height, and heart rate (r 2 = 0.257). The current data suggest that, despite lower central systolic blood pressure, patients with DMD have higher wave reflection when compared to normal controls, which may represent increased arterial stiffness. Overall there appears to be no effect on ventricular systolic function, however the long-term consequence in this group is unknown. Further study is required to determine the mechanism of these differences, which may be related to the effects of systemic steroids or the role of dystrophin in vascular function.
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Affiliation(s)
- Thomas D Ryan
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA.
| | - John J Parent
- Division of Pediatric Cardiology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Zhiqian Gao
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA
| | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA
| | - Elizabeth Dupont
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA
| | - Jennifer N Smith
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA
| | - Brenda Wong
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA
| | - John L Jefferies
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45220, USA
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Impact of insulin resistance on cardiac and vascular function. Int J Cardiol 2016; 221:1095-9. [DOI: 10.1016/j.ijcard.2016.07.087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/04/2016] [Indexed: 12/25/2022]
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Terlemez S, Bulut Y, Ünüvar T, Tokgöz Y, Eryilmaz U, Çelik B. Evaluation of arterial stiffness in children with type 1 diabetes using the oscillometric method. J Diabetes Complications 2016; 30:864-7. [PMID: 27068268 DOI: 10.1016/j.jdiacomp.2016.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 01/24/2023]
Abstract
AIMS Pulse wave velocity (PWV) is an accepted evaluation method to assess vascular changes and determine cardiovascular disease risk in type 1 diabetes (T1D) patients. The aim of this study was to identify atherosclerosis risk by using oscillometric device in pediatric patients who had T1D but no end organ impairment and no cardiovascular disease findings. MATERIALS AND METHODS Pediatric patients with T1D and no determined end organ impairment and cardiovascular disease were involved in the study. RESULTS A total of 72 patients with T1D containing 32 males and 40 females were included in the study. A total of 77 patients including 39 males and 38 females were evaluated as healthy control group. The average age of patients with T1D was 12.8±3.7years, their average weight was established as 43.8±16.7kg. The average age of control group was 12.3±1.6years and average weight was determined as 46.8±12.8kg. When the results obtained by pulse wave method were compared; PWV and Alx_75 values in T1D patients (respectively, 4.63±0.40 and 22.9±6.7) were determined significantly higher than those of control group (respectively, 4.42±0.34 and 16.6±6.6). A positive correlation was identified between diabetes duration and HbA1c (instant and mean) levels in patients with T1D with respect to PWV and Alx_75 values. CONCLUSIONS Arterial stiffness was impaired in children with T1D with no end organ impairment using oscillometric method. This impairment was related to high HbA1c levels and diabetes duration.
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Affiliation(s)
- Semiha Terlemez
- Adnan Menderes University Medicine Faculty, Pediatric Cardiology Department, Aydin, Turkey.
| | - Yasin Bulut
- Adnan Menderes University, Department of Pediatric, Aydin, Turkey
| | - Tolga Ünüvar
- Adnan Menderes University, Department of Pediatric Endocrinology Aydin, Turkey
| | - Yavuz Tokgöz
- Adnan Menderes University, Department of Pediatric, Aydin, Turkey
| | - Ufuk Eryilmaz
- Adnan Menderes University, Medical Faculty, Department of Cardiology, Aydin, Turkey
| | - Bülent Çelik
- Gazi University Chemistry Faculty Statistics, Ankara, Turkey
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Shah AS, Dabelea D, Fino NF, Dolan LM, Wadwa RP, D'Agostino R, Hamman R, Marcovina S, Daniels SR, Urbina EM. Predictors of Increased Carotid Intima-Media Thickness in Youth With Type 1 Diabetes: The SEARCH CVD Study. Diabetes Care 2016; 39:418-25. [PMID: 26721813 PMCID: PMC4764035 DOI: 10.2337/dc15-1963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/03/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Youth with type 1 diabetes have worse cardiovascular (CV) risk factors and higher carotid intima-media thickness (IMT) than their peers without diabetes. Whether the burden of CV risk factors over time is associated with carotid IMT at follow-up in youth with type 1 diabetes is not known. RESEARCH DESIGN AND METHODS Two hundred ninety-eight youth with type 1 diabetes (mean age 13.3 ± 2.9 years, 87.6% non-Hispanic white, 53.7% male) had two study visits 5 years apart. CV risk factors, including BMI, lipids, blood pressure, hemoglobin A(1c), and smoking status, were assessed at both visits, and carotid IMT was measured at follow-up using B-mode ultrasonography. Linear regression models with an area under the curve measurement that incorporated the baseline and follow-up CV risk factors were used to evaluate the relationship with carotid IMT at follow-up. RESULTS All CV risk factors worsened significantly over time (except LDL cholesterol) (P < 0.05). From baseline to follow-up, the number of abnormal CV risk factors also increased (P < 0.05). Predictors of carotid IMT were older age, male sex, and higher BMI z score area under the curve (all P < 0.05). CONCLUSIONS The CV risk factor burden increases over time in youth with type 1 diabetes. BMI z score was the only modifiable CV risk factor that predicted carotid IMT. This study highlights the critical need to better understand the risk factors that influence carotid IMT early in the course of type 1 diabetes.
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Affiliation(s)
- Amy S Shah
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Lawrence M Dolan
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - R Paul Wadwa
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Richard Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Elaine M Urbina
- Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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Bradley TJ, Slorach C, Mahmud FH, Dunger DB, Deanfield J, Deda L, Elia Y, Har RLH, Hui W, Moineddin R, Reich HN, Scholey JW, Mertens L, Sochett E, Cherney DZI. Early changes in cardiovascular structure and function in adolescents with type 1 diabetes. Cardiovasc Diabetol 2016; 15:31. [PMID: 26879273 PMCID: PMC4754808 DOI: 10.1186/s12933-016-0351-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/05/2016] [Indexed: 01/24/2023] Open
Abstract
Background Children with type 1 diabetes (T1D) are at higher risk of early adult-onset cardiovascular disease. We assessed cardiovascular structure and function in adolescents with T1D compared with healthy controls and the relationships between peripheral vascular function and myocardial parameters. Methods and results 199 T1D [14.4 ± 1.6 years, diabetes duration 6.2 (2.0–12.8) years] and 178 controls (14.4 ± 2.1 years) completed endothelial function by flow mediated vasodilatation (FMD), arterial stiffness using pulse wave velocity (PWV) along with M-mode, pulse wave and tissue Doppler, and myocardial deformation echocardiographic imaging. Systolic (113 ± 10 vs. 110 ± 9 mmHg; p = 0.0005) and diastolic (62 ± 7 vs. 58 ± 7 mmHg; p < 0.0001) blood pressures, carotid femoral PWV and endothelial dysfunction measurements were increased in T1D compared with controls. Systolic and diastolic left ventricular dimensions and function by M-mode and pulse wave Doppler assessment were not significantly different. Mitral valve lateral e’ (17.6 ± 2.6 vs. 18.6 ± 2.6 cm/s; p < 0.001) and a’ (5.4 ± 1.1 vs. 5.9 ± 1.1 cm/s; p < 0.001) myocardial velocities were decreased and E/e’ (7.3 ± 1.2 vs. 6.7 ± 1.3; p = 0.0003) increased in T1D. Left ventricular mid circumferential strain (−20.4 ± 2.3 vs. −19.5 ± 1.7 %; p < 0.001) was higher, whereas global longitudinal strain was lower (−19.0 ± 1.9 vs. −19.8 ± 1.5 % p < 0.001) in T1D. Conclusions Adolescents with T1D exhibit early changes in blood pressure, peripheral vascular function and left ventricular myocardial deformation indices with a shift from longitudinal to circumferential shortening. Longitudinal follow-up of these changes in ongoing prospective trials may allow detection of those most at risk for cardiovascular abnormalities including hypertension that could preferentially benefit from early therapeutic interventions.
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Affiliation(s)
- Timothy J Bradley
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Cameron Slorach
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Farid H Mahmud
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - David B Dunger
- Department of Pediatrics, University of Cambridge, Cambridge, UK.
| | - John Deanfield
- University College Hospital, London, UK. .,Heart Hospital and Great Ormond Street Hospital, London, UK.
| | - Livia Deda
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Yesmino Elia
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Ronnie L H Har
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Wei Hui
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Heather N Reich
- Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada.
| | - James W Scholey
- Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada.
| | - Luc Mertens
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Etienne Sochett
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada.
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Athyros VG, Mikhailidis DP. High incidence of metabolic syndrome further increases cardiovascular risk in patients with type 2 diabetes. Implications for everyday practice. J Diabetes Complications 2016; 30:9-11. [PMID: 26275865 DOI: 10.1016/j.jdiacomp.2015.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Vascular Prevention Clinics, Royal Free Hospital Campus, University College Medical School, University College London, London, UK
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