Relationship of Cardiac Structure and Function to Cardiorespiratory Fitness and Lean Body Mass in Adolescents and Young Adults with Type 2 Diabetes

Bacha, Fida; Gidding, Samuel S.; Pyle, Laura; Katz, Lorraine Levitt; Kriska, Andrea M.; Nadeau, Kristen J.; Lima, João A.C.; Adolescents, Treatment Options for Type Diabetes in

doi:10.1016/j.jpeds.2016.06.048

Cited by 16 publications

(11 citation statements)

References 30 publications

(42 reference statements)

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“…In obese adolescents enrolled in the TODAY Study, FM was positively associated with E/E' (i.e. worse LV diastolic function) [31]. The finding of higher E/E' in DS vs nonDS adolescents suggests stiffer left ventricles are present in DS; this difference was present regardless of underlying CHD status.…”

Section: Discussionmentioning

confidence: 86%

“…In adult athletes, physical training and greater fitness are associated with higher LVM and enhanced LV diastolic function [28][29][30]. In obese adolescents enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study, LVM was associated with LBM and cardiorespiratory fitness, as measured by a submaximal test with cycle ergometry [31]. While moderate-to-vigorous physical activity trended toward lower in the DS cohort, lower LVM remained even after adjustment for this reduced cardiovascular physical activity.…”

Section: Discussionmentioning

confidence: 99%

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Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome

et al. 2018

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome

et al. 2018

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“…In addition, total body and abdominal adiposity were significant determinants of coronary artery calcifications in these youth ( 239 ). In TODAY, echocardiographic evaluation revealed a relationship of BMI and blood pressure with adverse cardiac measures ( 240 ), though there was a protective effect of cardiorespiratory fitness on functional measures of cardiac structure and function in this group of largely sedentary youth ( 241 ). Overall, studies to date indicate significant vascular dysfunction and greater risk of progression to overt CVD in youth with obesity and type 2 diabetes.…”

Section: Prevention and Management Of Diabetes Complicationsmentioning

confidence: 99%

Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association

et al. 2018

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Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications. PATHOPHYSIOLOGY Glucose homeostasis is maintained by a balance between insulin secretion from the pancreatic b-cells and sensitivity to insulin in skeletal muscle, adipose tissue, and liver (1). When insulin sensitivity declines, insulin secretion must increase to maintain glucose tolerance, and, in most youth, decreased insulin sensitivity due to puberty and/or obesity is compensated by increased insulin secretion. However, when b-cells cannot secrete sufficient insulin to compensate for insulin resistance, abnormalities in glucose homeostasis ensue, potentially progressing to prediabetes and type 2 diabetes as b-cell function deteriorates further (2-9). The relationship between b-cell function and insulin sensitivity in adults and youth has been demonstrated to be a hyperbolic function and can be described mathematically as the product of insulin sensitivity and b-cell function, called the disposition index (DI) (1). The DI essentially expresses the amount of insulin being secreted relative to the degree of insulin resistance and is a constant for a given degree of glucose tolerance in any one individual. Overweight and obesity are major acquired contributors to the development of insulin resistance, particularly in the face of the physiologic insulin resistance characteristic of puberty. Robust pancreatic b-cell compensatory insulin secretion maintains normal glucose homeostasis. However, in adolescents with obesity who develop type 2 diabetes, there is severe peripheral and hepatic insulin resistance, with ;50% lower peripheral insulin sensitivity than peers with obesity without diabetes, along with increased fasting hepatic glucose production and inadequate firstand second-phase insulin secretion, resulting in ;85% lower DI (2). Additional abnormalities in youth with type 2 diabetes include impaired glucose sensitivity of insulin secretion, lower serum adiponectin concentrations, and reduced incretin effect (3,9-13). While upregulation of a-cell function with hyperglucagonemia has been implicated in the pathophysiology of type 2 diabetes in adults (14,15), there are limited data in youth with type 2 diabetes, with studies showing either hyperglucagonemia or no difference from control subjects without diabetes (3,11,16,17). Cross-sectional and longitudinal studies in youth with obesity along the spectrum of glycemia from normoglycemia to prediabetes to type 2 diabetes show, as in adults, that b-cell failure with declining insulin secretion relative to insulin sensitivity results in prediabetes and type 2 diabetes in high-risk youth (5-9,18-21). Importantly, however, prior to reaching the American Diabetes Association (...

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“…1). There is clear evidence of elevated left ventricular mass, abnormal cardiac geometry and impaired diastolic function, reduced cardiopulmonary fitness, abnormal limb blood flow, arterial stiffness and higher blood pressure, as well as renal hyperfiltration, in both diabetes types compared with peers without diabetes with a similar BMI [24,[48][49][50][51][52][53][54][55][56][57][58][59]. However, some comorbidities including low HDL-cholesterol and elevated triacylglycerol, hepatic fat [54] and liver transaminases [60], and non-alcoholic steatohepatitis (NASH) [61] are not typically present in youth with type 1 diabetes, especially in those with a normal BMI.…”

Section: Comorbidities and Complicationsmentioning

confidence: 99%

The changing face of paediatric diabetes

Shah

Nadeau

2020

Diabetologia

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The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.

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Relationship of Cardiac Structure and Function to Cardiorespiratory Fitness and Lean Body Mass in Adolescents and Young Adults with Type 2 Diabetes

Cited by 16 publications

References 30 publications

Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome

Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome

Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association

The changing face of paediatric diabetes

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