Prevalence of Cardiovascular Disease Risk Factors in U.S. Children and Adolescents With Diabetes The SEARCH for Diabetes in Youth Study

University of Washington Seattle, Seattle, Washington, United States
Diabetes Care (Impact Factor: 8.42). 08/2006; 29(8):1891-6. DOI: 10.2337/dc06-0310
Source: PubMed


The purpose of this study was to determine the prevalence and correlates of selected cardiovascular disease (CVD) risk factors among youth aged <20 years with diabetes.
The analysis included 1,083 girls and 1,013 boys examined as part of the SEARCH for Diabetes in Youth study, a multicenter, population-based study of youth 0-19 years of age with diabetes. Diabetes type was determined by a biochemical algorithm based on diabetes antibodies and fasting C-peptide level. CVD risk factors were defined as follows: HDL cholesterol <40 mg/dl; age- and sex-specific waist circumference >90th percentile; systolic or diastolic blood pressure >90th percentile for age, sex, and height or taking medication for high blood pressure; and triglycerides >110 mg/dl.
The prevalence of having at least two CVD risk factors was 21%. The prevalence was 7% among children aged 3-9 years and 25% in youth aged 10-19 years (P < 0.0001), 23% among girls and 19% in boys (P = 0.04), 68% in American Indians, 37% in Asian/Pacific Islanders, 32% in African Americans, 35% in Hispanics, and 16% in non-Hispanic whites (P < 0.0001). At least two CVD risk factors were present in 92% of youth with type 2 and 14% of those with type 1A diabetes (P < 0.0001). In multivariate analyses, age, race/ethnicity, and diabetes type were independently associated with the odds of having at least two CVD risk factors (P < 0.0001).
Many youth with diabetes have multiple CVD risk factors. Recommendations for weight, lipid, and blood pressure control in youth with diabetes need to be followed to prevent or delay the development of CVD as these youngsters mature.

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    • "However, it is unclear whether these associations are independent of each other, with one study showing insulin resistance is associated with oxLDL but not independent of obesity as defined by BMI [10], while another study showed insulin resistance is associated with oxLDL independent of body fatness [9]. Moreover, whether these associations are applicable to Latino adolescents, a population at increased risk for CVD [12], is unknown. Therefore the objective of this study was to determine the independent associations between IR, abdominal adiposity, and oxLDL levels in Latino adolescents. "
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    ABSTRACT: Abdominal obesity and insulin resistance (IR) place youth at higher risk for premature cardiovascular disease (CVD), but the underlying mechanisms are not clear. In adults, abdominal obesity and IR contribute to the oxidation of low-density lipoprotein (LDL). Whether similar mechanisms are operational in Latino adolescents is unknown. Therefore, we determined whether IR and abdominal adiposity are associated with higher oxLDL concentrations in Latino adolescents. Data from 123 Latino adolescents (16.3 +/- 2.5 years; female = 74) were used for the present analysis. Participants were assessed for waist circumference, fasting serum oxLDL, and insulin sensitivity by the whole body insulin sensitivity index. In separate linear regression models adjusting for age and sex, both waist circumference and insulin sensitivity were significant predictors of oxLDL (beta = 1.9; p = 0.002; R2 = 0.13, beta = -1.7; p = 0.006; R2 = 0.11, respectively). When insulin sensitivity and waist circumference were included in the same model, both remained independent predictors of oxLDL (beta = 1.7; p = 0.016 and, beta = -1.5; p = 0.055, respectively; R2 = 0.16). These results suggest that insulin resistance and abdominal adiposity are associated with higher levels of LDL oxidation which may be a mechanism contributing to increased CVD risk in Latino adolescents.
    Full-text · Article · Nov 2013 · Diabetology and Metabolic Syndrome
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    • "A combination of obesity prevalence and demographic composition of our local community may place our type 1 diabetes population at particularly high risk for IR as well as related macro- and microvascular complications (3,20). Given the high rates of type 2 diabetes often found among Hispanics and blacks, it is not surprising that a significant percentage of our type 1 diabetes clinic cohort shows features of “double diabetes,” that is, evidence of type 2 diabetes features (including greater waist circumference, higher triglycerides, and lower HDL) in the lowest eGDR tertile (10,11). "
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    ABSTRACT: OBJECTIVE Insulin resistance has been described in type 1 diabetes mellitus, is related to risk of vascular complications, and may be more common in certain ethnic groups. Estimated glucose disposal rate (eGDR) is a validated clinical tool for estimating insulin sensitivity in type 1 diabetes. Because previous reports of eGDR in adults with type 1 diabetes have included few ethnic minorities, this study explored interethnic differences in eGDR and the relationship of eGDR with diabetic vascular complications.RESEARCH DESIGN AND METHODS We conducted a cross-sectional study using a sample that included 207 white, black, or Hispanic adults with prior clinical diagnosis of type 1 diabetes who were receiving care at an urban academic medical center. eGDR (milligrams per kilogram per minute) was calculated using HbA1c, waist circumference, and hypertensive status. Race/ethnicity was self-reported. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CIs of association of eGDR with diabetes complications (cardiovascular disease, retinopathy, albuminuria, and chronic kidney disease above stage 3).RESULTSForty-two percent of the participants were women, and mean age was 45 ± 15 years; 34% were white, 32% were Hispanic, and 34% were black. Ethnicity was significantly associated with eGDR; blacks had significantly lower eGDR (5.66 ± 2.34) than Hispanics (6.70 ± 2.29) and whites (7.20 ± 2.03) (P < 0.001). Patients with the lowest eGDR compared with the highest had a significantly greater risk of any diabetes complication (OR 3.1 [95% CI 1.2-8.1]) compared with the least insulin-resistant patients.CONCLUSIONS In an urban clinic population of patients with type 1 diabetes, blacks were significantly less insulin sensitive than whites or Hispanics, and lower eGDR was associated with diabetes complications. Further study is needed to determine whether using eGDR to target interventions can improve outcomes.
    Full-text · Article · Apr 2013 · Diabetes care
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    • "Cardiovascular disease is the major cause of mortality in adults over 30 years of age with type 1 diabetes [13]. Evidence suggests atherosclerosis begins during adolescence, with elevated risk of adult cardiovascular disease in adolescents with known risk factors [14] [15], underscoring the importance of elucidating influences on risk factor development in this population. "
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    ABSTRACT: Aims: Weight gain is an oft-cited outcome of improved glycemic control in adults with type 1 diabetes, though few studies have investigated this in youth. The purpose of this paper was to examine cross-sectional and longitudinal associations of body mass index (BMI, kg/m(2)) with glycemic control in youth with type 1 diabetes (n=340, 12.5 ± 1.7 year, 49% female, duration ≥ 1 year) participating in a 2-year multi-center intervention study targeting family diabetes management. Methods: BMI was calculated from height and weight measured at clinic visits. Glycohemoglobin (HbA1c) at each visit was assayed centrally. Cross-sectional associations of baseline BMI with glycemic control, and of change in BMI and HbA1c with baseline values, were examined. Longitudinal associations of time-varying BMI and HbA1c were examined using a multilevel linear mixed effects model controlling for time-varying time (months), insulin dose (units/kg/day), regimen, Tanner stage, and time invariant baseline diabetes duration, BMI, treatment group and sociodemographic characteristics. Results: Baseline HbA1c was unrelated to baseline BMI, but was related positively to subsequent BMI change (p=0.04) and inversely to HbA1c change (p=0.002). Baseline BMI was inversely related to BMI change (p=0.01) and unrelated to HbA1c change. In multilevel regression, BMI was related inversely to HbA1c (%) (β ± SE=-0.11 ± 0.02, p<0.001) and positively to insulin dose (0.23 ± 0.07, p=0.001). In the treatment group only, BMI was positively related to pump regimen (0.18 ± 0.08, p=0.02). Conclusions: Increased insulin administered to improve glycemic control may contribute to increased BMI in youth with type 1 diabetes, indicating the importance of determining ways to minimize weight gain while optimizing glycemic control.
    Full-text · Article · Jan 2013 · Diabetes research and clinical practice
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