Insulin sensitivity and arterial stiffness in youth with type 1 diabetes: the SEARCH CVD study

Abstract

Aims Decreased insulin sensitivity is a cardiovascular risk factor (CVRF) in youth with type 1 diabetes (T1D). Whether baseline insulin sensitivity is independently associated with changes in early arterial stiffness (pulse wave velocity (PWV)) over time in youth with T1D is not known. Methods 298 youth with T1D in the SEARCH CVD study had PWV measured ~five years apart. Insulin sensitivity and other CVRFs were measured at baseline. The association between baseline insulin sensitivity with PWV over time was explored using linear mixed models. Models were adjusted for baseline age, sex and race, with subsequent adjustment for CVRFs. Results There was a significant interaction (p=0. 0326) between baseline insulin sensitivity and time on PWV, independent of CVRFs, indicating that higher insulin sensitivity levels were associated with lower rate of change in PWV over time. Other significant predictors of PWV change were baseline age [β=0.007 (p=0.03) increase in logPWV/ year increase in age] and mean arterial blood pressure (MAP) [β=0.005 (p<0.01) increase in logPWV/ mmHg increase in MAP] and smoking status (current vs. never smoker). Conclusions Lower insulin sensitivity at baseline appears to be an important risk factor for increased arterial stiffness over time in youth with T1D. This identifies a potentially modifiable therapeutic target.

Predictors of Increased Carotid Intima-Media Thickness in Youth With Type 1 Diabetes: The SEARCH CVD Study

“…The goal of the follow-up study was to recruit >200 adolescents with type 1 diabetes from the original cohort. This report includes 298 youth who completed both baseline and follow-up SEARCH CVD visits (16,17). The study was reviewed and approved by each local institutional review board, and all participants provided written informed consent or assent.…”

“…The baseline and follow-up research visits followed the same standard protocol (16,17). Each visit was conducted after at least an 8-h fast.…”

“…Measurements of HbA 1c , total cholesterol, triglycerides, and HDL cholesterol (HDL-C) were performed as previously described (17). LDL cholesterol (LDL-C) was calculated by the Friedewald equation or measured by beta quantification if triglycerides were ≥400 mg/dL.…”

Early changes in cardiovascular structure and function in adolescents with type 1 diabetes

“…The development of abnormal ventricular function in diabetes is multifactorial and has been attributed to metabolic disturbances, renal impairment, myocardial fibrosis, small vessel disease, cardiac autonomic neuropathy, and insulin resistance [ 1 , 2 ]. In adults longer duration of diabetes is associated with impairment of systolic and diastolic function [ 3 ].…”

The importance of pulse wave velocity measurement in paediatric population with an increased risk of cardiovascular diseases - Type 1 diabetes and chronic kidney disease

“…Zvýšení periferní tuhosti bylo přítomno ve vyšším procentu pacientů (33 % u periferní vs. 9 % u aortální) a více u chlapců [39]. Studie SEARCH při hodnocení vlivu kouření na cfPWV u adolescentů s DM1 navíc prokázala, že přes vyšší PWV u adolescentů, kteří pravidelně kouřili, byl nezávislým prediktorem cfPWV status DM1, a nikoliv kouření (adjustovaný model) [40].…”