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Journal Article Observational Study Ppublish 15 citations

PubMed: 34542729 DOI: 10.1007/s00592-021-01796-6

Longitudinal changes in vascular stiffness and heart rate variability among young adults with youth-onset type 2 diabetes: results from the follow-up observational treatment options for type 2 diabetes in adolescents and youth (TODAY) study.

Acta Diabetol 59(2):197-205

Authors: Amy S Shah, Laure El Ghormli, Samuel S Gidding, Kara S Hughan, Lorraine E Levitt Katz, Dorit Koren, Jeanie B Tryggestad, Fida Bacha, Barbara H Braffett, Silva Arslanian, Elaine M Urbina

Affiliations

  • Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, OH, USA.
  • George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD, 20852, USA.
  • Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, DE, USA.
  • University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
  • Children's Hospital of Philadelphia, Philadelphia, PA, USA.
  • Massachusetts General Hospital, Boston, MA, USA.
  • University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
  • Children's Nutrition Research Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD, 20852, USA.

Abstract

AIMS

(1) To describe changes in arterial stiffness and heart rate variability (HRV) over a 5-year interval, (2) examine changes by sex and race-ethnicity, and (3) evaluate the risk factors associated with the longitudinal changes in arterial stiffness and HRV.

METHODS

Participants with youth-onset type 2 diabetes enrolled in the observational follow-up phase of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial had arterial stiffness [(pulse wave velocity, augmentation index, brachial distensibility] and six indices of HRV measured 5 years apart. Multivariable linear regression models assessed risk factors associated with changes in the outcomes over time.

RESULTS

At initial vascular assessment, the 304 participants were a mean age of 21 years, 34% male, and had a mean diabetes duration of 8 years. In more than half the cohort pulse wave velocity, augmentation index and HRV increased over 5 years (p<0.01). Brachial distensibility did not change. There were no differences in the 5-year change by race/ethnicity except for a single HRV measure, where non-Hispanic Blacks had greater worsening of parasympathetic function compared to non-Hispanic Whites, p = 0.008. Blood pressure was related to greater worsening in augmentation index and pulse wave velocity. Higher hemoglobin A1c over time was related to worsening pulse wave velocity and HRV.

CONCLUSIONS

Arterial stiffness and HRV worsened over 5 years. Blood pressure and glycemic control may be potential targets to influence adverse changes in arterial stiffness and HRV in young adults with youth-onset type 2 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00081328.

MeSH

Diabetes Mellitus, Heart Rate, Heart, Adolescent, Risk Factors, Therapeutics, Vascular Stiffness, Pulse, Diabetes Mellitus, Type 2

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