Obesity flags high-risk cardiorenal profile in youth with type 1 diabetes
medwireNews: Adolescents with type 1 diabetes who are obese have a cardiorenal risk profile similar to that of their peers with type 2 diabetes, say researchers.
“Thus, although data previously indicated that long-term outcomes of youth-onset [type 2 diabetes] appeared to portend higher cardiovascular and kidney risk than in youth-onset [type 1 diabetes], this gap may narrow if obesity continues to rise in [type 1 diabetes],” the team writes in Diabetes Care.
“Consequently, closer attention to weight-loss strategies and lifestyle management is critical in youth with [type 1 diabetes] to help mitigate the risk for future [cardiovascular disease].”
Indeed, Kristen Nadeau (Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, USA) and colleagues found that obese participants with type 1 diabetes had the highest average systolic blood pressure of all the groups they studied, at an average of 124 mmHg.
The team studied 284 adolescents aged 12–21 years, including 135 with type 1 diabetes and 59 with type 2 diabetes, plus 43 lean and 47 obese adolescents without diabetes. All subgroups with diabetes had similar glycated hemoglobin levels.
Average systolic blood pressure in the type 2 diabetes group was only slightly lower than that of obese adolescents with type 1 diabetes, at 121 mmHg, but just 12% of this group had hypertension, compared with 44% of the obese adolescents with type 1 diabetes. Hypertension was also common in overweight participants with type 1 diabetes, at 26%, with an average systolic blood pressure of 123 mmHg.
By comparison, 11% of the obese participants without diabetes had hypertension, although the average systolic blood pressure was lower than that of the adolescents with diabetes, at 116 mmHg.
Diastolic blood pressure, mean arterial pressure, and heart rate were also highest in participants with type 1 diabetes and obesity, with values in the overweight group being the same or only slightly lower, and in all cases higher than in the adolescents with type 2 diabetes and the obese participants without diabetes.
In the type 1 diabetes group, all blood pressure measures plus heart rate significantly correlated with BMI.
Measures of kidney function were worst in participants with type 2 diabetes, with 31% and 33% having microalbuminuria and hyperfiltration, respectively. However, all participants with type 1 diabetes had higher rates of microalbuminuria than the controls without diabetes, at 12–18% versus 0–3%, and renal measures did not correlate with BMI in this group.
“These results support the conclusion that [type 1 diabetes] uniquely places individuals at risk for complications including cardiovascular dysfunction, independent of [glycated hemoglobin] and BMI,” concludes the team.
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