Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes

Abstract

Objective Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for HbA1c, blood pressure, lipids, and BMI. We hypothesized that ISPAD/ADA goal achievement at baseline would be associated with cardiorenal risk factors at baseline and 2 year follow-up in adolescents with type 1 diabetes. Methods We assessed the cross-sectional and longitudinal relationships between ISPAD/ADA goal achievement at baseline and cardiorenal health at baseline and 2-year follow-up (n=297; 15.4±2.1 years at baseline) in adolescents with type 1 diabetes. Goal achievement was defined as HbA1c<7.5%, BP<90th percentile for age, sex and height, LDL-C <100mg/dL, HDL-C >35mg/dL, TG <150mg/dL and BMI <85th percentile for age and sex. Cardiorenal outcomes included pulse-wave velocity (PWV), brachial distensibility (BrachD), augmentation index (AIx), and eGFR continuously and categorically as hyperfiltration (eGFR≥135mL/min/1.73m2). Results Adolescents with type 1 diabetes who met 1–3 goals, had significantly greater (P<0.05) baseline PWV (5.1±0.1 vs. 5.4±0.1 m/s), follow-up PWV (5.5±0.1 vs. 5.7±0.1 m/s), greater follow-up eGFR (104±2 vs. 116±3 mL/min/1.73m2), and greater odds of renal hyperfiltration at follow-up (OR: 20.0, 95% CI 3.8–105.2) compared to those who met 4–6 goals after adjusting for Tanner stage, sex, age and diabetes duration. No statistically significant differences in the cardiorenal outcomes were observed between adolescents with type 1 diabetes who met 4–6 goals and non-diabetic controls (n=96). Conclusions In adolescents with type 1 diabetes, baseline ADA/ISPAD goal achievement was associated with cardiorenal protection at baseline and 2-year follow-up.

Hyperfiltration and uricosuria in adolescents with type 1 diabetes

“…The Determinants of Macrovascular Disease in Adolescents with Type 1 Diabetes study was initiated to investigate atherosclerotic disease risk in youth with T1D [13, 14]. The study enrolled 300 subjects 12–19 years old from 2008 to 2010, with type 1 diabetes and 100 non-diabetic controls of similar age [13].…”

“…The study enrolled 300 subjects 12–19 years old from 2008 to 2010, with type 1 diabetes and 100 non-diabetic controls of similar age [13]. Study participants with T1D were diagnosed by islet cell antibody or by provider clinical diagnosis, had diabetes duration >5 years at entry into the study, and received care at the Barbara Davis Center for Childhood Diabetes.…”

Leptin is associated with cardiopulmonary fitness independent of body-mass index and insulin sensitivity in adolescents with type 1 diabetes: a brief report from the EMERALD study

“…Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes (T1D) (1, 2) with abnormalities measurable in adolescence (3). In T1D youth we have reported an inverse relationship between insulin sensitivity (IS) and peak exercise capacity (VO 2 peak) (4).…”

Diabetes Complications in Childhood Diabetes: New Biomarkers and Technologies

“…Measures of arterial stiffness including pulse wave velocity (PWV), augmentation index (AIx) and brachial distensibility (BrachD) have been shown to predict future CVD and all-cause mortality [24–26] (Table 1). In adolescents with type 1 diabetes, we recently reported an inverse relationship between achieving International Society of Pediatric and Adolescents Diabetes’ targets for HbA1c, LDL-C, HDL-C, TG, BMI and BP and arterial stiffness (measured by PWV, AIx and BracD) [28]. Furthermore, we have shown that apoB is strongly associated with arterial stiffness by PWV in adolescents with type 1 diabetes, and that measurement of apoB in addition to LDL-C may be helpful in stratifying CVD-risk in adolescents with type 1 diabetes and borderline LDL-C (100–129mg/dL) [29].…”