Trends in Prevalence of Cardiovascular Risk Factors from 2002‐2012 among Youth Early in the Course of Type 1 and Type 2 Diabetes. The SEARCH for Diabetes in Youth Study

Abstract

Background: Given diabetes is an important risk factor for cardiovascular disease (CVD), we examined temporal trends in CVD risk factors by comparing youth recently diagnosed with type 1 diabetes (T1D) and type 2 diabetes (T2D) from 2002 through 2012. Methods: The SEARCH for Diabetes in Youth Study identified youth with diagnosed T1D (n = 3954) and T2D (n = 706) from 2002 to 2012. CVD risk factors were defined using the modified Adult Treatment Panel III criteria for metabolic syndrome: (a) hypertension; (b) high-density lipoprotein cholesterol ≤40 mg/dL; (c) triglycerides ≥110 mg/dL; and (d) waist circumference (WC) >90th percentile. Prevalence of CVD risk factors, stratified by diagnosis year and diabetes type, was reported. Univariate and multivariate logistic models and Poisson regression were fit to estimate the prevalence trends for CVD risk factors individually and in clusters (≥2 risk factors). Results: The prevalence of ≥2 CVD risk factors was higher in youth with T2D than with T1D at each incident year, but the prevalence of ≥2 risk factors did not change across diagnosis years among T1D or T2D participants. The number of CVD risk factors did not change significantly in T1D participants, but increased at an annual rate of 1.38% in T2D participants. The prevalence of hypertension decreased in T1D participants, and high WC increased in T2D participants. Conclusion: The increase in number of CVD risk factors including large WC among youth with T2D suggests a need for early intervention to address these CVD risk factors. Further study is needed to examine longitudinal associations between diabetes and CVD.

Dyslipidemia in adolescents and young adults with type 1 and type 2 diabetes: a retrospective analysis

“…Additionally, for patients with LDL-C not at goal, presence of other CVD risk factors of obesity and low HDL-C were associated with T2D than T1D. Our analysis is concordant with recent findings from the national multicenter SEARCH for Diabetes in Youth population, where the prevalence of > 2 CVD risk factors among youth with T2D was 8-10 times as high as youth with T1D [12]. These are consistent with studies showing youth onset T2D is associated with earlier complications than youth onset T1D or adults with T2D [9][10][11]37].…”

“…Despite these, the prevalence of dyslipidemia in our diabetes population is still high, which shows the need for improved management of dyslipidemia in pediatric patients with diabetes. Our study population is an ethnically diverse population with high Hispanic prevalence (57.8% of T2D and 22.9% of T1D), higher than that of the national multicenter SEARCH for Diabetes in Youth population (27.6% of T2D and 13.0% of the T1D), or of the NHANES (National Health and Nutrition Examination Survey) adolescent populations [12,28]. Racial disparities have been reported in both T1D and T2D where minorities compared to Non-Hispanic White tend to have increased CVD risk factors including dyslipidemia, however the relationship and mechanism is unclear and complicated [7,29,30].…”

“…Youth onset type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing in prevalence and associated with early atherosclerosis, CVD risk factors, vascular complications, and mortality [4][5][6][7][8][9]. Youth onset T2D compared to youth onset T1D is associated with earlier diabetes related complications, increased CVD risk factors, and increased mortality [10][11][12][13]. These underline the importance of screening for and treating CVD risk factors in all youth with both T1D and T2D.…”

The Impact of Diabetes Mellitus on Cardiovascular Risk Onset in Children and Adolescents

“…Moreover, in patients with T1D, CV outcomes and mortality inversely correlate with age at diabetes onset; thus suggesting that the earlier the onset, the greater the risk [ 18 ]. The prevalence of two or more CV disease risk factors is higher in younger patients with T2D (92%) than those with T1D (14%), and is increased by 1.4% on an annual basis, over the ten years of the study period, in patients with T2D, but not in those with T1D [ 23 , 24 ]. In line with the aforementioned study, Dabalea et al demonstrated that 72% of 272 young patients with T2D, contrasting only 32% of 1746 young patients with T1D, developed diabetic complications [ 25 ].…”

Progression to hypertension in youth and young adults with type 1 or type 2 diabetes: The SEARCH for Diabetes in Youth Study

“…The SEARCH study has previously shown that the number of cardiovascular risk factors did not change significantly in participants with type 1 diabetes, but increased over time in participants with type 2 diabetes, a diabetic phenotype with a higher prevalence of obesity at diagnosis 34 . Early complications of diabetes co‐occurred in adolescents and young adults with diabetes, and included arterial stiffness and hypertension 35 .…”