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Published in: Acta Diabetologica 2/2016

01-04-2016 | Original Article

Prevalence of cardiovascular risk factors in youth with type 1 diabetes and elevated body mass index

Authors: Maria J. Redondo, Nicole C. Foster, Ingrid M. Libman, Sanjeev N. Mehta, Joanne M. Hathway, Kathleen E. Bethin, Brandon M. Nathan, Michelle A. Ecker, Avni C. Shah, Stephanie N. DuBose, William V. Tamborlane, Robert P. Hoffman, Jenise C. Wong, David M. Maahs, Roy W. Beck, Linda A. DiMeglio

Published in: Acta Diabetologica | Issue 2/2016

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Abstract

Aim

The prevalence of cardiovascular risk factors in children with type 1 diabetes and elevated BMI in the USA is poorly defined. We aimed to test the hypothesis that children with type 1 diabetes who are overweight or obese have increased frequencies of hypertension, dyslipidemia, and micro-/macroalbuminuria compared to their healthy weight peers.

Methods

We studied 11,348 children 2 to <18 years of age enrolled in T1D Exchange between September 2010 and August 2012 with type 1 diabetes for ≥1 year and BMI ≥ 5th age-/sex-adjusted percentile (mean age 12 years, 49 % female, 78 % non-Hispanic White). Overweight and obesity were defined based on Centers for Disease Control and Prevention criteria. Diagnoses of hypertension, dyslipidemia, and micro-/macroalbuminuria were obtained from medical records. Logistic and linear regression models were used to assess factors associated with weight status.

Results

Of the 11,348 participants, 22 % were overweight and 14 % obese. Hypertension and dyslipidemia were diagnosed in 1.0 % and 3.8 % of participants, respectively; micro-/macroalbuminuria was diagnosed in 3.8 % of participants with available data (n = 7,401). The odds of either hypertension or dyslipidemia were higher in obese than healthy weight participants [OR 3.5, 99 % confidence interval (CI) 2.0–6.1 and 2.2, 99 % CI 1.6–3.1, respectively]. Obese participants tended to be diagnosed with micro-/macroalbuminuria less often than healthy weight participants (OR 0.6, 99 % CI 0.4–1.0).

Conclusions

Obese children with type 1 diabetes have a higher prevalence of hypertension and dyslipidemia than healthy weight children with type 1 diabetes. The possible association of obesity with lower micro-/macroalbuminuria rates warrants further investigation.
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Literature
1.
go back to reference Minino AM, Murphy SL, Xu J, Kochanek KD (2011) Deaths: final data for 2008. Natl Vital Stat Rep 59(10):1–126 Minino AM, Murphy SL, Xu J, Kochanek KD (2011) Deaths: final data for 2008. Natl Vital Stat Rep 59(10):1–126
2.
go back to reference Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB et al (2013) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245CrossRefPubMed Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB et al (2013) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245CrossRefPubMed
3.
go back to reference Maahs DM, Jalal D, Chonchol M, Johnson RJ, Rewers M, Snell-Bergeon JK (2013) Impaired renal function further increases odds of 6-year coronary artery calcification progression in adults with type 1 diabetes: the CACTI study. Diabetes Care 36(9):2607–2614CrossRefPubMedPubMedCentral Maahs DM, Jalal D, Chonchol M, Johnson RJ, Rewers M, Snell-Bergeon JK (2013) Impaired renal function further increases odds of 6-year coronary artery calcification progression in adults with type 1 diabetes: the CACTI study. Diabetes Care 36(9):2607–2614CrossRefPubMedPubMedCentral
4.
go back to reference Orchard TJ, Forrest KY, Kuller LH, Becker DJ, Pittsburgh Epidemiology of Diabetes Complications Study (2001) Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 24(6):1053–1059CrossRefPubMed Orchard TJ, Forrest KY, Kuller LH, Becker DJ, Pittsburgh Epidemiology of Diabetes Complications Study (2001) Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 24(6):1053–1059CrossRefPubMed
5.
go back to reference Pambianco G, Costacou T, Ellis D, Becker DJ, Klein R, Orchard TJ (2006) The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes 55(5):1463–1469CrossRefPubMed Pambianco G, Costacou T, Ellis D, Becker DJ, Klein R, Orchard TJ (2006) The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes 55(5):1463–1469CrossRefPubMed
6.
go back to reference Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM (2006) High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 29(4):798–804CrossRefPubMed Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM (2006) High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 29(4):798–804CrossRefPubMed
7.
go back to reference Barzilay JI, Spiekerman CF, Kuller LH, Burke GL, Bittner V, Gottdiener JS et al (2001) Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study. Diabetes Care 24(7):1233–1239CrossRefPubMed Barzilay JI, Spiekerman CF, Kuller LH, Burke GL, Bittner V, Gottdiener JS et al (2001) Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study. Diabetes Care 24(7):1233–1239CrossRefPubMed
8.
go back to reference Nishimura R, LaPorte RE, Dorman JS, Tajima N, Becker D, Orchard TJ (2001) Mortality trends in type 1 diabetes. The Allegheny County (Pennsylvania) Registry 1965–1999. Diabetes Care 24(5):823–827CrossRefPubMed Nishimura R, LaPorte RE, Dorman JS, Tajima N, Becker D, Orchard TJ (2001) Mortality trends in type 1 diabetes. The Allegheny County (Pennsylvania) Registry 1965–1999. Diabetes Care 24(5):823–827CrossRefPubMed
9.
go back to reference Krantz JS, Mack WJ, Hodis HN, Liu CR, Liu CH, Kaufman FR (2004) Early onset of subclinical atherosclerosis in young persons with type 1 diabetes. J Pediatr 145(4):452–457CrossRefPubMed Krantz JS, Mack WJ, Hodis HN, Liu CR, Liu CH, Kaufman FR (2004) Early onset of subclinical atherosclerosis in young persons with type 1 diabetes. J Pediatr 145(4):452–457CrossRefPubMed
10.
go back to reference Laing SP, Swerdlow AJ, Slater SD, Burden AC, Morris A, Waugh NR et al (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46:760–765CrossRefPubMed Laing SP, Swerdlow AJ, Slater SD, Burden AC, Morris A, Waugh NR et al (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46:760–765CrossRefPubMed
11.
go back to reference Wood JR, Miller KM, Maahs DM, Beck RW, DiMeglio LA, Libman IM et al (2013) Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care 36(7):2035–2037CrossRefPubMedPubMedCentral Wood JR, Miller KM, Maahs DM, Beck RW, DiMeglio LA, Libman IM et al (2013) Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care 36(7):2035–2037CrossRefPubMedPubMedCentral
12.
go back to reference Daniels M, DuBose SN, Maahs DM, Beck RW, Fox LA, Gubitosi-Klug R et al (2013) Factors associated with microalbuminuria in 7,549 children and adolescents with type 1 diabetes in the T1D Exchange clinic registry. Diabetes Care 36(9):2639–2645CrossRefPubMedPubMedCentral Daniels M, DuBose SN, Maahs DM, Beck RW, Fox LA, Gubitosi-Klug R et al (2013) Factors associated with microalbuminuria in 7,549 children and adolescents with type 1 diabetes in the T1D Exchange clinic registry. Diabetes Care 36(9):2639–2645CrossRefPubMedPubMedCentral
13.
go back to reference Margeirsdottir HD, Larsen JR, Brunborg C, Overby NC, Dahl-Jorgensen K, Norwegian Study Group for Childhood Diabetes (2008) High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia 51(4):554–561CrossRefPubMed Margeirsdottir HD, Larsen JR, Brunborg C, Overby NC, Dahl-Jorgensen K, Norwegian Study Group for Childhood Diabetes (2008) High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia 51(4):554–561CrossRefPubMed
14.
go back to reference Peppa-Patrikiou M, Scordili M, Antoniou A, Giannaki M, Dracopoulou M, Dacou-Voutetakis C (1998) Carotid atherosclerosis in adolescents and young adults with IDDM. Relation to urinary endothelin, albumin, free cortisol, and other factors. Diabetes Care 21(6):1004–1007CrossRefPubMed Peppa-Patrikiou M, Scordili M, Antoniou A, Giannaki M, Dracopoulou M, Dacou-Voutetakis C (1998) Carotid atherosclerosis in adolescents and young adults with IDDM. Relation to urinary endothelin, albumin, free cortisol, and other factors. Diabetes Care 21(6):1004–1007CrossRefPubMed
15.
go back to reference Kaminski BM, Klingensmith GJ, Beck RW, Tamborlane WV, Lee J, Hassan K et al (2013) Body mass index at the time of diagnosis of autoimmune type 1 diabetes in children. J Pediatr 162(4):736–740CrossRefPubMed Kaminski BM, Klingensmith GJ, Beck RW, Tamborlane WV, Lee J, Hassan K et al (2013) Body mass index at the time of diagnosis of autoimmune type 1 diabetes in children. J Pediatr 162(4):736–740CrossRefPubMed
16.
go back to reference Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C et al (2010) Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 11(1):4–11CrossRefPubMed Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C et al (2010) Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 11(1):4–11CrossRefPubMed
17.
go back to reference Purnell JQ, Zinman B, Brunzell JD (2013) The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation 127(2):180–187CrossRefPubMed Purnell JQ, Zinman B, Brunzell JD (2013) The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation 127(2):180–187CrossRefPubMed
18.
go back to reference Carmona-Cejudo JM, Hortas ML, Baena-Garcia M, Lana-Linati J, Gonzalez C, Redondo M et al (2012) DB4US: a Decision Support System for Laboratory Information Management. Interact J Med Res 1(2):e16CrossRefPubMedPubMedCentral Carmona-Cejudo JM, Hortas ML, Baena-Garcia M, Lana-Linati J, Gonzalez C, Redondo M et al (2012) DB4US: a Decision Support System for Laboratory Information Management. Interact J Med Res 1(2):e16CrossRefPubMedPubMedCentral
19.
go back to reference Goodman E, Dolan LM, Morrison JA, Daniels SR (2005) Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation 111(15):1970–1977CrossRefPubMed Goodman E, Dolan LM, Morrison JA, Daniels SR (2005) Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation 111(15):1970–1977CrossRefPubMed
20.
go back to reference Kavey RE, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW et al (2006) Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 114(24):2710–2738CrossRefPubMed Kavey RE, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW et al (2006) Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 114(24):2710–2738CrossRefPubMed
21.
go back to reference Redondo MJ, Rodriguez LM, Escalante M, O’Brian Smith E, Balasubramanyam A, Haymond MW (2012) Beta cell function and BMI in ethnically diverse children with newly diagnosed autoimmune type 1 diabetes. Pediatr Diabetes 13(7):564–571CrossRefPubMed Redondo MJ, Rodriguez LM, Escalante M, O’Brian Smith E, Balasubramanyam A, Haymond MW (2012) Beta cell function and BMI in ethnically diverse children with newly diagnosed autoimmune type 1 diabetes. Pediatr Diabetes 13(7):564–571CrossRefPubMed
22.
go back to reference Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ (2003) Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes. Diabetes Care 26(10):2871–2875CrossRefPubMed Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ (2003) Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes. Diabetes Care 26(10):2871–2875CrossRefPubMed
23.
go back to reference Sandhu N, Witmans MB, Lemay JF, Crawford S, Jadavji N, Pacaud D (2008) Prevalence of overweight and obesity in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 21(7):631–640CrossRefPubMed Sandhu N, Witmans MB, Lemay JF, Crawford S, Jadavji N, Pacaud D (2008) Prevalence of overweight and obesity in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 21(7):631–640CrossRefPubMed
24.
go back to reference Beck RW, Tamborlane WV, Bergenstal RM, Miller KM, Dubose SN, Hall CA (2012) The T1D Exchange clinic registry. J Clin Endocrinol Metab 97(12):4383–4389CrossRefPubMed Beck RW, Tamborlane WV, Bergenstal RM, Miller KM, Dubose SN, Hall CA (2012) The T1D Exchange clinic registry. J Clin Endocrinol Metab 97(12):4383–4389CrossRefPubMed
25.
go back to reference Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R et al (2002) CDC growth charts for the United States: methods and development. National Center for Health Statistics. Vital Health Stat 11(246):1–190 Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R et al (2002) CDC growth charts for the United States: methods and development. National Center for Health Statistics. Vital Health Stat 11(246):1–190
26.
go back to reference Barlow SE, Expert C (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(Suppl 4):S164–S192CrossRefPubMed Barlow SE, Expert C (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(Suppl 4):S164–S192CrossRefPubMed
27.
28.
go back to reference Anderson J, Pena AS, Sullivan T, Gent R, D’Arcy B, Olds T et al (2013) Does metformin improve vascular health in children with type 1 diabetes? Protocol for a one year, double blind, randomised placebo controlled trial. BMC Pediatr 13:108CrossRefPubMedPubMedCentral Anderson J, Pena AS, Sullivan T, Gent R, D’Arcy B, Olds T et al (2013) Does metformin improve vascular health in children with type 1 diabetes? Protocol for a one year, double blind, randomised placebo controlled trial. BMC Pediatr 13:108CrossRefPubMedPubMedCentral
29.
go back to reference Liu C, Wu D, Zheng X, Li P, Li L (2015) Efficacy and safety of metformin for patients with type 1 diabetes: a meta-analysis. Diabetes Technol Ther 17:142–148CrossRefPubMed Liu C, Wu D, Zheng X, Li P, Li L (2015) Efficacy and safety of metformin for patients with type 1 diabetes: a meta-analysis. Diabetes Technol Ther 17:142–148CrossRefPubMed
30.
go back to reference Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G et al (2007) Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Diabetes Care 30(10):2593–2598CrossRefPubMed Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G et al (2007) Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Diabetes Care 30(10):2593–2598CrossRefPubMed
31.
go back to reference Loghman-Adham M (1998) Evaluating proteinuria in children. Am Fam Physician 58(5):1145–1152, 1158–1159 Loghman-Adham M (1998) Evaluating proteinuria in children. Am Fam Physician 58(5):1145–1152, 1158–1159
32.
go back to reference Springberg PD, Garrett LE Jr, Thompson AL Jr, Collins NF, Lordon RE, Robinson RR (1982) Fixed and reproducible orthostatic proteinuria: results of a 20-year follow-up study. Ann Intern Med 97(4):516–519CrossRefPubMed Springberg PD, Garrett LE Jr, Thompson AL Jr, Collins NF, Lordon RE, Robinson RR (1982) Fixed and reproducible orthostatic proteinuria: results of a 20-year follow-up study. Ann Intern Med 97(4):516–519CrossRefPubMed
33.
go back to reference TODAY Study Group (2013) Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Care 36(6):1772–1774CrossRefPubMedCentral TODAY Study Group (2013) Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Care 36(6):1772–1774CrossRefPubMedCentral
34.
go back to reference Mohebi R, Simforoosh A, Tohidi M, Azizi F, Hadaegh F (2015) Obesity paradox and risk of mortality events in chronic kidney disease patients: A decade of follow-up in Tehran Lipid and Glucose Study. J Ren Nutr. doi:10.1053/jrn.2014.12.006 PubMed Mohebi R, Simforoosh A, Tohidi M, Azizi F, Hadaegh F (2015) Obesity paradox and risk of mortality events in chronic kidney disease patients: A decade of follow-up in Tehran Lipid and Glucose Study. J Ren Nutr. doi:10.​1053/​jrn.​2014.​12.​006 PubMed
35.
go back to reference TODAY Study Group (2013) Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care 36:1735–1741CrossRefPubMedCentral TODAY Study Group (2013) Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care 36:1735–1741CrossRefPubMedCentral
36.
go back to reference van Vliet M, Van der Heyden JC, Diamant M, Von Rosenstiel IA, Schindhelm RK, Aanstoot HJ et al (2010) Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk. J Pediatr 156(6):923–929CrossRefPubMed van Vliet M, Van der Heyden JC, Diamant M, Von Rosenstiel IA, Schindhelm RK, Aanstoot HJ et al (2010) Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk. J Pediatr 156(6):923–929CrossRefPubMed
37.
go back to reference Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS (2003) Regression of microalbuminuria in type 1 diabetes. N Engl J Med 348:2285–2293CrossRefPubMed Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS (2003) Regression of microalbuminuria in type 1 diabetes. N Engl J Med 348:2285–2293CrossRefPubMed
Metadata
Title
Prevalence of cardiovascular risk factors in youth with type 1 diabetes and elevated body mass index
Authors
Maria J. Redondo
Nicole C. Foster
Ingrid M. Libman
Sanjeev N. Mehta
Joanne M. Hathway
Kathleen E. Bethin
Brandon M. Nathan
Michelle A. Ecker
Avni C. Shah
Stephanie N. DuBose
William V. Tamborlane
Robert P. Hoffman
Jenise C. Wong
David M. Maahs
Roy W. Beck
Linda A. DiMeglio
Publication date
01-04-2016
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 2/2016
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-015-0785-1

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