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Qu Q, Guo Q, Shi J, Chen Z, Sun J, Cheang I, Gao R, Zhou Y, Zhang H, Liao S, Yao W, Li X. Trends in cardiovascular risk factor prevalence, treatment, and control among US adolescents aged 12 to 19 years, 2001 to March 2020. BMC Med 2024; 22:245. [PMID: 38872207 PMCID: PMC11170826 DOI: 10.1186/s12916-024-03453-5] [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: 01/02/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Early-life cardiovascular risk factors (CVRFs) are known to be associated with target organ damage during adolescence and premature cardiovascular morbidity and mortality during adulthood. However, contemporary data describing whether the prevalence of CVRFs and treatment and control rates have changed are limited. This study aimed to examine the temporal trends in the prevalence, treatment, and control of CVRFs among US adolescents over the past 2 decades. METHODS This is a serial cross-sectional study using data from nine National Health and Nutrition Examination Survey cycles (January 2001-March 2020). US adolescents (aged 12 to 19 years) with information regarding CVRFs (including hypertension, elevated blood pressure [BP], diabetes, prediabetes, hyperlipidemia, obesity, overweight, cigarette use, inactive physical activity, and poor diet quality) were included. Age-adjusted trends in CVRF prevalence, treatment, and control were examined. Joinpoint regression analysis was performed to estimate changes in the prevalence, treatment, and control over time. The variation by sociodemographic characteristics were also described. RESULTS A total of 15,155 US adolescents aged 12 to 19 years (representing ≈ 32.4 million people) were included. From 2001 to March 2020, there was an increase in the prevalence of prediabetes (from 12.5% [95% confidence interval (CI), 10.2%-14.9%] to 37.6% [95% CI, 29.1%-46.2%]) and overweight/obesity (from 21.1% [95% CI, 19.3%-22.8%] to 24.8% [95% CI, 21.4%-28.2%]; from 16.0% [95% CI, 14.1%-17.9%] to 20.3% [95% CI, 17.9%-22.7%]; respectively), no improvement in the prevalence of elevated BP (from 10.4% [95% CI, 8.9%-11.8%] to 11.0% [95% CI, 8.7%-13.4%]), diabetes (from 0.7% [95% CI, 0.2%-1.2%] to 1.2% [95% CI, 0.3%-2.2%]), and poor diet quality (from 76.1% [95% CI, 74.0%-78.2%] to 71.7% [95% CI, 68.5%-74.9%]), and a decrease in the prevalence of hypertension (from 8.1% [95% CI, 6.9%-9.4%] to 5.5% [95% CI, 3.7%-7.3%]), hyperlipidemia (from 34.2% [95% CI, 30.9%-37.5%] to 22.8% [95% CI, 18.7%-26.8%]), cigarette use (from 18.0% [95% CI, 15.7%-20.3%] to 3.5% [95% CI, 2.0%-5.0%]), and inactive physical activity (from 83.0% [95% CI, 80.7%-85.3%] to 9.5% [95% CI, 4.2%-14.8%]). Sex and race/ethnicity affected the evolution of CVRF prevalence differently. Whilst treatment rates for hypertension and diabetes did not improve significantly (from 9.6% [95% CI, 3.5%-15.8%] to 6.0% [95% CI, 1.4%-10.6%]; from 51.0% [95% CI, 23.3%-78.7%] to 26.5% [95% CI, 0.0%-54.7%]; respectively), BP control was relatively stable (from 75.7% [95% CI, 56.8%-94.7%] to 73.5% [95% CI, 40.3%-100.0%]), while glycemic control improved to a certain extent, although it remained suboptimal (from 11.8% [95% CI, 0.0%-31.5%] to 62.7% [95% CI, 62.7%-62.7%]). CONCLUSIONS From 2001 to March 2020, although prediabetes and overweight/obesity increased, hypertension, hyperlipidemia, cigarette use, and inactive physical activity decreased among US adolescents aged 12 to 19 years, whereas elevated BP, diabetes, and poor diet quality remained unchanged. There were disparities in CVRF prevalence and trends across sociodemographic subpopulations. While treatment and control rates for hypertension and diabetes plateaued, BP control were stable, and improved glycemic control was observed.
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Affiliation(s)
- Qiang Qu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qixin Guo
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jinjing Shi
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ziqi Chen
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jinyu Sun
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Iokfai Cheang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Rongrong Gao
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yanli Zhou
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, 26 Daoqian Street, Suzhou, 215002, China
- Department of Cardiology, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shengen Liao
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Wenming Yao
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Xinli Li
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Marigliano M, Lanzinger S, Zineb I, Barcala C, Shah AS, Svensson J, Tsochev K, Mazur A, Galli-Tsinopoulou A, Ioacara S, Jothydev K, Maffeis C. The role of sex on the prevalence of cardiovascular risk factors in children and adolescents with Type 1 diabetes: The SWEET international database. Diabetes Res Clin Pract 2024; 210:111616. [PMID: 38490494 DOI: 10.1016/j.diabres.2024.111616] [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: 12/14/2023] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To assess the prevalence of cardiovascular risk factors (CVRFs) in children and adolescents with type 1 diabetes (T1D) in the International SWEET registry and the possible role of clinical variables in modifying the risk of having single or multiple CVRFs. STUDY DESIGN The study is a cross-sectional study. Cut-off points for CVRFs were fixed according to International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and WHO parameters: LDL cholesterol (LDL-C) > 100 mg/dL; Systolic Blood Pressure (BP-SDS) > 90th percentile for sex, age, and height; BMI-SDS > 2SD for sex and age. Logistic regression models were applied to evaluate variables associated with at least 1 or 2 CVRFs among registry children and adolescents. RESULTS 29,649 individuals with T1D (6-18 years, T1D ≥ 2 years) participating in the SWEET prospective multicenter diabetes registry were included. In the cohort, 41 % had one or more CVRFs, and 10 % had two or more CVRFs. Thirty-five percent of enrolled individuals had LDL-C > 100 mg/dL, 26 % had BMI-SDS > 2SD, and 17 % had Systolic BP-SDS > 90th percentile. Females had higher frequency than males of having 1 or 2 CVRFs (45.1 % vs 37.4 %, 11.8 % vs 7.8 %; p < 0.001). Multivariable logistic regression models showed that sex (female), HbA1c category (>7.0 %), and age (>10 years) were associated with a higher chance of having at least 1 or 2 CVRFs (p < 0.001). CONCLUSIONS In children and adolescents with T1D, female sex, in addition to HbA1c above 7 %, and older age (>10 years) was associated with a higher risk of having at least a CVRF (LDL-C, BMI-SDS, BP) according to internationally defined cut-offs.
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Affiliation(s)
- Marco Marigliano
- Regional Center for Pediatric Diabetes, University of Verona, University City Hospital, Verona, Italy.
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Imane Zineb
- Unit of Pediatric Diabetology, Children's Hospital Rabat, UM5S, Morocco
| | | | - Amy S Shah
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology & The University of Cincinnati. Cincinnati, OH, USA
| | - Jannet Svensson
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University Varna, UMHAT "Sv. Marina" Varna, Bulgaria
| | - Artur Mazur
- Department Pediatrics, Pediatric Endocrinology and Diabetes, University of Rzeszow, Poland
| | - Assimina Galli-Tsinopoulou
- Unit of Pediatric Endocrinology and Diabetes, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Sorin Ioacara
- Carol Davila University of Medicine and Pharmacy, Elias University Emergency Hospital, Bucharest, Romania
| | | | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University of Verona, University City Hospital, Verona, Italy
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Fridolfsson C, Thegerström J, Åkesson K, Engvall J, Blomstrand P. Lower left atrial function in young individuals with type 1 diabetes mellitus compared to healthy controls: an echocardiographic study. Sci Rep 2024; 14:3982. [PMID: 38368449 PMCID: PMC10874446 DOI: 10.1038/s41598-024-54597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
In adulthood, individuals with type 1 diabetes mellitus may develop a condition of heart failure with preserved ejection fraction. However, subclinical changes to the heart in diabetes are likely to occur prior to the clinical presentation. This cross-sectional study aimed to compare left atrial function by echocardiography between 43 individuals with type 1 diabetes and 43 healthy controls, aged 10-30 years. All participants underwent echocardiography and 2D speckle tracking measurements for left atrial phase function parameters. Physical capacity was assessed by exercise test on a bicycle. Results showed that participants with type 1 diabetes had significantly lower left atrial function parameters than healthy controls (p < 0.05). There was a significant negative correlation between HbA1c means and reservoir and conduit strain (p < 0.05) and individuals with BMI < 30 showed a lower left atrial stiffness (p < 0.05). Individuals with type 1 diabetes and a higher physical capacity did not differ from their healthy peers. Results indicate that lower HbA1c levels, BMI < 30 and a higher physical capacity are favourable in terms of left atrial function in children and young adults with type 1 diabetes mellitus. Left atrial strain by echocardiography might become a new important tool in assessing heart function in T1DM.
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Affiliation(s)
- Cecilia Fridolfsson
- Department of Clinical Physiology in Kalmar, Region Kalmar County, Kalmar, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Johanna Thegerström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics in Kalmar, Region Kalmar County, Kalmar, Sweden
- Faculty of Health and Life Sciences (FHL), Linnaeus University, Kalmar, Sweden
| | - Karin Åkesson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, Linköping University Hospital, Linköping, Sweden
| | - Peter Blomstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Drozd I, Weiskorn J, Lange K, Biester T, Datz N, Kapitzke K, Reschke F, von dem Berge T, Weidemann J, Danne TPA, Kordonouri O. Prevalence of LDL-hypercholesterolemia and other cardiovascular risk factors in young people with type 1 diabetes. J Clin Lipidol 2023; 17:483-490. [PMID: 37258406 DOI: 10.1016/j.jacl.2023.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Mortality and morbidity in people with Type 1 diabetes (T1D) is mainly caused by cardiovascular disease (CVD). Early treatment of cardiovascular risk factors (CVRFs) is of great importance. OBJECTIVE To analyze the prevalence of LDL-hypercholesterolemia and other CVRFs in youth with T1D. METHODS Clinical and laboratory parameters, and vascular thickness measurement were obtained in youth with T1D (age 6-18 years, T1D duration >1 year) attending a diabetes clinic. LDL-hypercholesterolemia, microalbuminuria and arterial hypertension were defined as CVRFs. RESULTS A total of 333 youth (48% girls; age: 13.3 years [10.3-15.5], median [interquartile range]) participated in the study. The T1D duration was 5.9 years [3.5-9.4] with HbA1c of 7.4% [6.8-8.0]. Intima media thickness (N=223) was 538.0 µm [470.0-618.0]). LDL-hypercholesterolemia was present in 30 participants (9%; 18 girls; age: 14.3 years [11.2-15.7]). None of the participants had persistent microalbuminuria, although 59 (18.3%) had elevated albumin excretion in a random urine specimen. LDL-hypercholesterolemia was associated with increased blood pressure (p<0.05), insulin requirement (p<0.05), HbA1c (p<0.05), triglyceride (p<0.001) and total cholesterol (p<0.001), and a family history of premature CVD (p<0.001), but negatively correlated with HDL cholesterol levels (p<0.05). Sex, pubertal status, duration of diabetes, type of therapy, and physical activity did not differ between participants with and without LDL- hypercholesterolemia. Arterial hypertension was present in 11 participants (3.3%; 4 girls; age: 14.1 years [11.1-16.1]). CONCLUSION LDL-hypercholesterolemia affected 9% of youth with T1D in this cohort and was associated with other CVRFs. A holistic therapeutic concept for these young people is essential.
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Affiliation(s)
- Irena Drozd
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany; Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Jantje Weiskorn
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Torben Biester
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Nicolin Datz
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Kerstin Kapitzke
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Felix Reschke
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Thekla von dem Berge
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Jürgen Weidemann
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | | | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany.
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Šumnik Z, Pavlíková M, Neuman V, Petruželková L, Konečná P, Venháčová P, Škvor J, Pomahačová R, Neumann D, Vosáhlo J, Strnadel J, Kocourková K, Obermannová B, Šantová A, Plachý L, Průhová S, Cinek O. Glycemic Control by Treatment Modalities: National Registry-Based Population Data in Children and Adolescents with Type 1 Diabetes. Horm Res Paediatr 2023; 97:70-79. [PMID: 37100041 DOI: 10.1159/000530833] [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: 01/22/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA. METHODS CwD younger than 19 years with T1D duration >1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups. RESULTS Data of a total of 3,251 children (mean age 13.4 ± 3.8 years) were analyzed. 2,187 (67.3%) were treated with MDI, 1,064 (32.7%) with insulin pump, 585/1,064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3) and lowest GRI 29.1 (7.8), both p < 0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (nonsignificant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 [IQR 4.5], 50.7 [4.5], and 52.7 [5.7] mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality. CONCLUSION This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.
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Affiliation(s)
- Zdenek Šumnik
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Marketa Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czechia
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Lenka Petruželková
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Petra Konečná
- Department of Pediatrics, University Hospital Brno, Brno, Czechia
| | - Petra Venháčová
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czechia
| | - Jaroslav Škvor
- Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, Czechia
| | - Renata Pomahačová
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czechia
| | - David Neumann
- Department of Pediatrics, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Jan Vosáhlo
- Department of Pediatrics, 3rd Faculty of Medicine, Prague, Czechia
| | - Jiri Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia
| | - Kamila Kocourková
- Department of Pediatrics, Hospital České Budějovice, České Budějovice, Czechia
| | - Barbora Obermannová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Alzbeta Šantová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
- 1st Faculty of Medicine, Prague, Czechia
| | - Lukas Plachý
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Stepanka Průhová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Ondrej Cinek
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
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