Obesity drives higher CV, renal risks for adolescents with type 1 diabetes
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Cardiovascular and metabolic derangements observed among adolescents with type 1 diabetes and obesity parallel those of youths with type 2 diabetes, suggesting a critical need for lifestyle management, data show.
“Insulin resistance is commonly present in type 1 diabetes and contributes to the increased risk for cardiovascular disease,” Kristen J. Nadeau, MD, MS, professor of pediatrics and research director of pediatric endocrinology and pediatric bariatric surgery at the University of Colorado Anschutz Medical Campus, told Healio. “Despite having insulin resistance, patterns of some CV risk factors differ among youths with type 1 diabetes vs. those with type 2 diabetes, implying different underlying mechanisms. Rates of obesity are now rising in type 1 diabetes, which further worsens the insulin resistance underlying type 1 diabetes and worsens underlying CV risk factors. Our early findings in this large cohort raise concern that a combination of obesity and type 1 diabetes in youth may predict outcomes as severe as youth-onset type 2 diabetes.”
CV profile worse with type 1 diabetes
Nadeau and colleagues analyzed data from 284 pubertal adolescents and young adults aged 12 to 21 years (mean age, 16 years) with type 1 diabetes (n = 135), type 2 diabetes (n = 59) or without diabetes (n = 90), stratified by BMI. Researchers assessed resting heart rate and blood pressure, as well as measures of inflammation (high-sensitivity C-reactive protein, adiponectin) and renal health (urine albumin-to-creatinine ratio, estimated glomerular filtration rate). Participants with type 1 diabetes underwent bicycle ergometry to assess peak oxygen uptake, vascular monitoring for peripheral brachial artery distensibility, endothelial function testing for reactive hyperemic index and aortic MRI for central arterial stiffness and shear.
Resting heart rate was significantly higher among youths with type 1 diabetes and obesity compared with controls with obesity, lean participants with type 1 diabetes, and those with type 2 diabetes. Similarly, systolic and diastolic BP were higher among participants with type 1 diabetes who were lean or obese vs. their respective BMI-stratified control groups.
“Systolic BP and diastolic BP, as well as their corresponding percentiles, increased with increasing BMI across the type 1 diabetes groups, with the obese type 1 diabetes group not differing significantly from the type 2 diabetes group,” the researchers wrote.
Researchers also found the prevalence of hypertension was highest among youths with type 1 diabetes and obesity and was significantly higher vs. controls with obesity, lean participants with type 1 diabetes and youths with type 2 diabetes.
Mean arterial pressure increased across the type 1 diabetes BMI groups, with an observed difference among those with type 1 diabetes and overweight and obesity compared with lean participants with type 1 diabetes.
Brachial artery distensibility-assessed peripheral arterial stiffness was greater among participants with type 1 diabetes and obesity vs. lean participants with type 1 diabetes. MRI-assessed central aortic stiffness was greatest for those with type 1 diabetes in the overweight group.
Addressing obesity
“We need to rethink the approach to treatment of type 1 diabetes in youths as primarily focused on teaching on how to cover the carbohydrates in food with insulin,” Nadeau said. “Instead, we need to move to an early multidisciplinary approach pairing insulin treatment with support for a healthy body weight in youths with type 1 diabetes, including an early emphasis on encouraging regular physical activity, heart-healthy food choices and appropriate portion sizes.”
The researchers noted that findings demonstrate that a higher BMI portends a more abnormal CV profile among adolescents with type 1 diabetes that is similar to worse than that for youths with type 2 diabetes.
“Research into novel ways to deliver insulin and potential adjunct treatments to accompany insulin to help prevent or reduce excess weight gain and/or prevent CVD development are also needed,” Kalie L. Tommerdahl, MD, a research fellow at the University of Colorado Denver Anschutz Medical Campus, told Healio. “Longer-term follow-up of youth with obesity and type 1 diabetes is needed to better understand if the elevated risk factors we identified translate long-term into increased CVD and mortality risk as they would in other populations. We also need more research into why and how the mechanisms underlying insulin resistance and CV risk in type 1 vs. type 2 diabetes differ, and how this should influence treatment approaches.”
For more information:
Kristen J. Nadeau, MD, MS, can be reached at kristen.nadeau@childrenscolorado.org.
Kalie L. Tommerdahl, MD, can be reached at kalie.tommerdahl@childrenscolorado.org.
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