ROME — Youth with type 2 diabetes had an average of nearly three cardiovascular risk factors each, compared with just one among healthy controls in an analysis of 295 participants in a large, multicenter, U.S. case-control study.
The data come from 106 patients with type 2 diabetes and 189 healthy controls (matched for age, sex, and race/ethnicity) recruited by primary care providers at two sites (Colorado and South Carolina) of the six sites participating in the federally-funded SEARCH for Diabetes in Youth, a study designed to investigate the prevalence and characteristics of diabetes among individuals aged younger than 20 years (www.searchfordiabetes.org
The current analysis, one of the first to look specifically at cardiovascular (CV) risk in youth with type 2 diabetes, also revealed that not all of the risk factors could be accounted for by increased obesity and/or hyperglycemia. “We believe that our data support the statement that early prevention and treatment strategies aimed at reducing the prevalence of cardiovascular risk factors in youth with type 2 diabetes mellitus are urgently needed,” Dr. Dana Dabelea said at the annual meeting of the European Association for the Study of Diabetes.
Participants were aged 10–22 years, with a mean of 16 years for the diabetic group and 14 years for the controls. (This was a statistically significant difference, despite attempts to age-match.) Duration of diabetes in the type 2 group was 1.5 years. Females comprised 69% of the diabetic group and 60% of controls, not significantly different, said Dr. Dabelea, director of the epidemiology PhD program at the University of Colorado, Denver, and a principal investigator at the SEARCH Colorado site.
The type 2 group was significantly more likely than were the controls to be African American (55% vs. 29%) and less likely to be non-Hispanic white (28% vs. 54%). The proportion of Hispanics was 17% in both groups. Body mass index was significantly greater among the youth with diabetes (35 vs. 24 kg/m
Consumption of saturated fat as a percent of total daily calories was slightly higher in the type 2 group, while the amount of daily physical activity was lower, but these did not reach statistical significance.
Highly statistically significant differences were seen between the two groups in the proportions—adjusted for age and race/ethnicity—who had hypertension, defined as systolic or diastolic blood pressure of 95th percentile or greater for age, sex, height, or medication (27% in the type 2 group vs. 5% of controls), low HDL cholesterol, defined as 35 mg/dL or below (25% of the type 2 group vs. 5% of controls) and high triglycerides, of 150 mg/dL or higher (27% vs. 6%).
Also highly significantly different were the proportions who were obese, defined as 95th percentile or greater BMI for age and sex (86% vs. 26%) and those who had a large waist circumference, defined as 90th percentile or greater for age and sex (82% vs. 22%).
Elevated albumin/creatinine ratio of 30 mcg/mg or greater was present in 17% of the type 2 group vs. 7% of controls, of borderline significance. The proportions of patients with high LDL cholesterol (130 mg/dL or greater) and who were current smokers were not significantly different, she said.
Nearly half (45%) of the controls had none of these CV risk factors, compared with just 3% of those with type 2 diabetes. In contrast, 60% of the type 2 patients had three or more risk factors, compared with just 13% of the nondiabetic controls. Those with type 2 diabetes had a mean of 2.9 CV risk factors each, compared with 1 for the controls.
The type 2 group also had a less favorable profile of nontraditional CV risk factors, including significantly lower levels of adiponectin and LDL particle density, and higher levels of apolipoprotein B, fibrinogen, and interleukin-6.
In a series of multiple linear regression models, adjustment for differences in obesity accounted for the differences between the type 2 group and the controls in HDL cholesterol, systolic blood pressure, and adiponectin, while adjustment for hemoglobin A1c between the groups accounted for the differences in apolipoprotein B and LDL particle size. Adjustment for both obesity and HbA1c accounted for the difference in triglycerides.