March 04, 2021
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The cardiovascular and metabolic disorders observed in adolescents with type 1 diabetes and obesity are the same as those seen in adolescents with type 2 diabetes, indicating a critical need for lifestyle management, data show.
“Insulin resistance is common in type 1 diabetes and contributes to the increased risk of cardiovascular disease.” Kristen J. Nadeau, MD, MS, Healio said, Professor of Pediatrics and Director of Research in Pediatric Endocrinology and Pediatric Bariatric Surgery at the University of Colorado’s Anschutz Medical Campus. “Despite insulin resistance, the patterns of some CV risk factors in adolescents with type 1 diabetes differ from those in type 2 diabetes, implying different underlying mechanisms. The rate of obesity is now increasing in type 1 diabetes, which further worsens the insulin resistance that underlies type 1 diabetes and worsens the underlying CV risk factors. Our early results in this large cohort give cause for concern that a combination of obesity and type 1 diabetes can predict outcomes as serious in adolescents as they do in adolescents with type 2 diabetes. “
Nadeau is a Professor of Pediatrics and Director of Research in Pediatric Endocrinology and Pediatric Bariatric Surgery at the University of Colorado’s Anschutz Medical Campus.
CV profile with type 1 diabetes worse
Nadeau and colleagues analyzed data from 284 adolescents and young adults aged 12 to 21 years (mean age 16 years) with type 1 diabetes (n = 135), type 2 diabetes (n = 59) or without diabetes ( n = 90). , stratified by BMI. Researchers assessed resting heart rate and blood pressure, as well as measurements of inflammation (highly sensitive C-reactive protein, adiponectin) and kidney health (urine albumin to creatinine ratio, estimated glomerular filtration rate). Participants with type 1 diabetes underwent bicycle ergometry to determine maximum oxygen uptake, vascular monitoring for distensibility of the peripheral brachial artery, endothelial function tests for reactive hyperemic index, and aortic MRI for stiffness and shear of the central arteries.
Kalie L. Tommerdahl
The resting heart rate was significantly higher in adolescents with type 1 diabetes and obesity than in control subjects with obesity, lean participants with type 1 diabetes, and those with type 2 diabetes. Similarly, the systolic and diastolic blood pressures of participants with type 1 diabetes who were lean or obese were higher than their respective BMI-stratified controls.
“Systolic blood pressure and diastolic blood pressure and the corresponding percentiles increased with increasing BMI in the type 1 diabetes groups, with the obese type 1 diabetes group not being significantly different from the type 2 diabetes group,” the researchers wrote.
The researchers also found that the prevalence of high blood pressure was highest in adolescents with type 1 diabetes and obesity, and was significantly higher than in control subjects with obesity, lean participants with type 1 diabetes, and adolescents with type 2 diabetes .
The mean arterial pressure increased in the BMI groups for type 1 diabetes, with a difference observed between patients with type 1 diabetes, overweight and obesity compared to lean participants with type 1 diabetes.
The peripheral arterial stiffness, as determined by the extensibility of the brachial artery, was higher in participants with type 1 diabetes and obesity than in lean participants with type 1 diabetes. MRI-assessed stiffness of the central aorta was greatest in patients with type 1 diabetes in the overweight group.
Fight obesity
“We need to rethink the approach to treating type 1 diabetes in adolescents as our primary focus is teaching how to insulin cover the carbohydrates in foods,” said Nadeau. “Instead, we need to move to an early multidisciplinary approach that combines insulin treatment with the support of healthy body weight in adolescents with type 1 diabetes, including an early focus on promoting regular physical activity, heart-healthy eating habits and appropriate portion sizes.”
The researchers found that the results show that a higher BMI indicates a more abnormal CV profile in adolescents with type 1 diabetes that is similarly worse than adolescents with type 2 diabetes.
“Research into novel ways of delivering insulin and potential add-on treatments to accompany insulin to prevent or reduce excessive weight gain and / or prevent the development of CVD is also needed.” Kalie L. Tommerdahl, MD, Healio said, a research fellow at the University of Colorado’s Anschutz Medical Campus in Denver. “Long-term follow-up care for adolescents with obesity and type 1 diabetes is necessary in order to better understand whether the increased risk factors we have identified lead to an increased risk of CVD and mortality in the long term, as would be the case in other population groups. We also need to examine more closely why and how the mechanisms underlying insulin resistance and CV risk differ in type 1 and type 2 diabetes, and how this should influence treatment approaches. “
For more informations:
Kristen J. Nadeau, MD, MS, can be reached at kristen.nadeau@childrenscolorado.org.
Kalie L. Tommerdahl, MD, can be reached at kalie.tommerdahl@childrenscolorado.org.
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