Measures of arterial stiffness in youth with type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth study
- R. Paul Wadwa, MD (Paul.Wadwa{at}ucdenver.edu)1,
- Elaine M. Urbina, MD2,
- Andrea M. Anderson, MS3,
- Richard F. Hamman, MD, DrPH4,
- Lawrence M. Dolan, MD2,
- Beatriz L. Rodriguez, MD, PhD5,
- Stephen R. Daniels, MD, PhD6,
- Dana Dabelea, MD, PhD4 and
- for the SEARCH study group
- 1 Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado
- 2 Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3 Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- 4 Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
- 5 Pacific Health Research Institute, Honolulu, Hawaii
- 6 Department of Pediatrics, University of Colorado School of Medicine, The Children's Hospital, Aurora, Colorado
Abstract
Objective: Arterial stiffness (AS) occurs early in the atherosclerotic process; however, few data are available concerning risk factors for AS in youth with diabetes. We identified factors associated with AS in youth with diabetes, and assessed the effects of these factors on the relationship between AS and diabetes type (type 1 vs. type 2).
Research Design and Methods: A sub-set of SEARCH patients with type 1 (N=535) and type 2 diabetes (N=60), age 10-23 years (52% male, 82% non-Hispanic white, diabetes duration 65±49 months) had AS, anthropometrics, blood pressure, fasting lipids, and hemoglobin A1c measured. AS was measured by brachial distensibility (brachD), pulse wave velocity (PWV) and augmentation index adjusted to heart rate of 75 beats/minute (AI75).
Results: Youth with type 2 diabetes had worse brachD (5.2±0.9 vs. 6.1±1.2 %/mmHg), PWV (6.4±1.3 vs. 5.3±0.8 m/sec), and AI75 (6.4±9.9 vs. 2.2±10.2 %) than those with type 1 diabetes (p<0.01 for each). These differences were largely mediated through increased central adiposity and higher blood pressure in youth with type 2 diabetes. We also found a pattern of association of AS measures with waist circumference and blood pressure, independent of diabetes type.
Conclusions: Youth with type 2 diabetes have worse arterial stiffness than similar youth with type 1 diabetes. Increased central adiposity and blood pressure are associated with measures of arterial stiffness, independent of diabetes type. Whether these findings indicate that youth with type 2 diabetes will be at higher risk for future complications requires longitudinal studies.
Footnotes
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- Received April 20, 2009.
- Accepted January 5, 2010.
- Copyright © American Diabetes Association
