Insulin Resistance in Adolescents with Type 1 Diabetes and Its Relationship to Cardiovascular Function

Nadeau, Kristen J.; Regensteiner, Judith G.; Bauer, Timothy A.; Brown, Mark S.; Dorosz, Jennifer L.; Hull, Amber; Zeitler, Philip; Draznin, Boris; Reusch, Jane E.B.

doi:10.1210/jc.2009-1756

Cited by 265 publications

(348 citation statements)

References 46 publications

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“…Previous magnetic resonance imaging studies have shown that diabetes was associated with LV hypertrophic remodeling regardless of age and gender [16,17] . These results were confirmed by echocardiographic studies where LV remodeling was associated with abnormalities of diastolic function in patients with type 1 diabetes [18,19] . Previous echocardiographic studies in diabetic children focused on LV diastolic function and suggested a reduction in early diastolic filling based on transmitral flow analysis [20,21] .…”

Section: Left Ventricular Morphology and Functionsupporting

confidence: 53%

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Hodžić

Ribault

Maragnès

et al. 2016

Journal of Translational Internal Medicine

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Background and Objectives: Type 1 diabetes is a major cardiovascular risk factor associated with an excess of mortality in young adults due to premature cardiovascular events, which includes heart failure. The relation between type 1 diabetes and cardiac structure and function in children was poorly documented. Our study investigates (1) whether type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction assessed by tissue Doppler strain and (2) whether state of metabolic control and diabetes duration have any influence on the cardiac event. Methods: Standard echocardiography and tissue Doppler imaging were prospectively performed in type 1 diabetic children. Left ventricular dimensions, standard indices of systolic and diastolic function, and septal longitudinal strain were investigated. Results: Thirty consecutive asymptomatic diabetic children (age: 12.4 [5-17] years; males: 53%) were compared to 30 age and sex-matched healthy control subjects. Left ventricular mass index and diastolic septal thickness were significantly increased in diabetic children. There was no difference between two groups as regards the left ventricular ejection fraction and conventional mitral Doppler parameters (E, A, Ea). The global longitudinal systolic strain and strain rate were found to be decreased in children with diabetes. The global longitudinal early diastolic strain rate (Esr) was negatively correlated with metabolic control. Longitudinal strain was not correlated with diabetes duration. Conclusion: Children with Type 1 diabetes had subclinical alterations in left ventricular size and longitudinal myocardial deformation.

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Section: Left Ventricular Morphology and Functionsupporting

confidence: 53%

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Hodžić

Ribault

Maragnès

et al. 2016

Journal of Translational Internal Medicine

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“…Insulin resistance is increased in youth with T1D compared to non-diabetic youth of similar age, sex, and BMIz, especially in children who fail to achieve target HbA1c levels (31,32). As insulin resistance increases so do cardiovascular disease risk factors (33).…”

Section: Discussionmentioning

confidence: 99%

Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States

DuBose

Hermann²,

Tamborlane

et al. 2015

The Journal of Pediatrics

151

124

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“…Exercise training improved aerobic capacity in this study without affecting glucose control in the participants with diabetes, suggesting that the effects of glycemic status and exercise training may work independently to improve aerobic capacity. Nadeau et al (35) have recently shown that insulin resistance may independently decrease exercise capacity in nonobese youth with type 1 diabetes, being a stronger correlate than HbA 1c . We did not directly measure insulin resistance in our study, but insulin dose decreased by ;10% after training, an indirect measure of insulin sensitivity.…”

Section: Resultsmentioning

confidence: 99%

Exercise Training Improves but Does Not Normalize Left Ventricular Systolic and Diastolic Function in Adolescents With Type 1 Diabetes

et al. 2017

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OBJECTIVETo determine the impact of 20 weeks of exercise training in aerobic capacity on left ventricular function and glycemic control in adolescents with and without type 1 diabetes. RESEARCH DESIGN AND METHODSFifty-three adolescents with type 1 diabetes (aged 15.6 years) were divided into two groups: exercise training (n = 38) and nontraining (n = 15). Twenty-two healthy adolescents without diabetes (aged 16.7 years) were included and, with the 38 participants with type 1 diabetes, participated in a 20-week exercise-training intervention. Assessments included VO 2max and body composition. Left ventricular parameters were obtained at rest and during acute exercise using MRI. RESULTSExercise training improved aerobic capacity (10%) and stroke volume (6%) in both trained groups, but the increase in the group with type 1 diabetes remained lower than trained control subjects. Increased stroke volume in adolescents with type 1 diabetes resulted from greater left ventricular contractility (9% increase in ejection fraction and an 11% reduction in end-systolic volumes) and, to a lesser extent, improved left ventricular filling (6%), suggesting that impaired diastolic function can be affected by exercise training in adolescents with type 1 diabetes. Insulin use decreased by ∼10%, but no change in glycemic status was observed. CONCLUSIONSThese data demonstrate that in adolescents, the impairment in left ventricular function seen with type 1 diabetes can be improved, although not normalized, with regular intense physical activity. Importantly, diastolic dysfunction, a common mechanism causing heart failure in older subjects with diabetes, appears to be partially reversible in this age group.Regular physical activity has many potential health benefits, and there is strong evidence of its role in the primary and secondary prevention of chronic diseases such as cardiovascular disease and diabetes (1). In particular, exercise training improves exercise capacity and cardiac output by increasing left ventricular function (2-5). Training increases left ventricular stroke volume by enhancing intrinsic cardiac contractility

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Insulin Resistance in Adolescents with Type 1 Diabetes and Its Relationship to Cardiovascular Function

Abstract: T1D youth demonstrated IR, impaired functional exercise capacity and cardiovascular dysfunction. The phenotype of IR in T1D youth was unique, suggesting a pathophysiology that is different from T2D, yet may adversely affect long-term cardiovascular outcomes.

Cited by 265 publications

References 46 publications

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States

Exercise Training Improves but Does Not Normalize Left Ventricular Systolic and Diastolic Function in Adolescents With Type 1 Diabetes

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