ROME — Youth with type 2 diabetes had an average of nearly three cardiovascular risk factors each, compared with just one in 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 participating in the federally funded SEARCH for Diabetes in Youth, a study designed to investigate the prevalence and characteristics of diabetes in individuals aged younger than 20 years.
The current analysis, one of the first to focus on cardiovascular (CV) risk in this population, also showed that not all the risk factors could be accounted for by increased obesity and/or hyperglycemia.
The data appear to “support the statement that early prevention and treatment strategies [to reduce] 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.
The participants were aged 10–22 years, with a mean of 16 years for the diabetic group and 14 years for the controls—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 Colorado site.
The type 2 group was significantly more likely than were the controls to be African American (55% vs. 29%, respectively) and less likely to be non-Hispanic white (28% vs. 54%). Body mass index was significantly greater in 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, and the amount of daily physical activity was lower, but these were not statistically significant.
Highly statistically significant differences between the groups were seen in the proportions who had hypertension (27% in the type 2 group vs. 5% of controls), were on medication (5% of controls), had low HDL cholesterol (25% vs. 5%, respectively), and high triglycerides (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% in the type 2 group vs. 26% of controls) and those with 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, compared with 7% of controls, of borderline significance. Proportions of those with high LDL cholesterol 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 3% of those with type 2 diabetes. In type 2 patients, 60% had three or more risk factors, compared with 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.
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 obesity and HbA1c accounted for the difference in triglycerides. But levels of the inflammatory markers fibrinogen and IL-6 remained significantly different between the two groups, even after adjustment for obesity and hemoglobin A1c, Dr. Dabelea said.