Impact of Obesity on Measures of Cardiovascular and Kidney Health in Youth With Type 1 Diabetes as Compared With Youth With Type 2 Diabetes
Open Access
- 5 January 2021
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 44 (3), 795-803
- https://doi.org/10.2337/dc20-1879
Abstract
Insulin resistance and obesity are independently associated with type 1 diabetes (T1D) and are known risk factors for cardiovascular and kidney diseases, the leading causes of death in T1D. We evaluated the effect of BMI on cardiovascular and kidney outcomes in youth with T1D versus control youth with normal weight or obesity and youth with type 2 diabetes (T2D). Pubertal youth (n = 284) aged 12–21 years underwent assessments of resting heart rate (RHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), leptin, hs-CRP, adiponectin, ratio of urine albumin to creatinine, and estimated glomerular filtration rate. Participants with T1D underwent bicycle ergometry for VO2peak, monitoring for peripheral brachial artery distensibility (BAD), endothelial function testing for reactive hyperemic index, and aortic MRI for central arterial stiffness or shear. In adolescents with T1D, RHR, SBP, DBP, mean arterial pressure, leptin, hs-CRP, and hypertension prevalence were significantly higher, and BAD, descending aorta pulse wave velocity, and VO2peak lower with an obese versus normal BMI. Although hypertension prevalence and RHR were highest in obese adolescents with T1D and adiponectin lowest in youth with T2D, other measures were similar between obese adolescents with T1D and those with T2D. Obesity, now increasingly prevalent in people with T1D, correlates with a less favorable cardiovascular and kidney risk profile, nearly approximating the phenotype of youth with T2D. Focused lifestyle management in youth-onset T1D is critically needed to reduce cardiovascular risk.Keywords
Funding Information
- National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK116720)
- JDRF (2-SRA-2018-627-M-B, 2-SRA-2019-845-S-B)
- National Heart, Lung, and Blood Institute (5 K24 HL145076-02)
- NIDDK (T32 DK063687, K23 DK107871)
- American Diabetes Association (7-11-CD-08)
- NIDDK (K23 DK107871)
- National Center for Advancing Translational Sciences (UL1 TR002535)
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