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Longitudinal Changes in Arterial Stiffness and Heart Rate Variability In Youth-Onset Type 1 vs Type 2 Diabetes: The SEARCH for Diabetes in Youth Study

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posted on 06.06.2022, 00:10 authored by Amy S Shah, Scott Isom, Ralph D’Agostino, Lawrence M Dolan, Dana Dabelea, Giuseppina Imperatore, Amy Mottl, Eva Lustigova, Catherine Pihoker, Santica Marcovina, Elaine M Urbina
Objectives. We compared arterial stiffness and heart rate variability (HRV) over time by diabetes type and determined the risk factors associated with worsening arterial stiffness and HRV in young adults with youth-onset diabetes.

Research Design and Methods: Arterial stiffness (pulse wave velocity, augmentation index) and six indices of heart rate variability were measured twice, 4.5 years apart among participants with either youth-onset type 1 or type 2 diabetes in the SEARCH for Diabetes in Youth Study. Multivariable linear regression models assessed risk factors associated with arterial stiffness and HRV at follow-up assessment.

Results. Of 1159 participants studied, 949 had type 1 (mean age 17.1 ± 4.7 years, 60.3% non-Hispanic White, 55% female) and 210 had type 2 diabetes (mean age 22.1 ± 3.5 years, 23.8% non-Hispanic White, 71% female) at initial assessment when diabetes duration was 7.9 years (both groups). Participants with type 2 vs type 1 diabetes had greater vascular stiffness and more abnormalities in HRV at initial and follow-up assessment and a greater change over time (all p<0.05). Risk factors associated with worse arterial stiffness and HRV at follow-up in both types of diabetes included higher blood pressure, hemoglobin A1c, waist circumference, and triglycerides, and longer diabetes duration.

Conclusions. Arterial stiffness and HRV worsened over time with greater changes among those with type 2 compared with type 1 diabetes, and among those with features of the metabolic syndrome. The risk factor profile documents potentially modifiable pathways to prevent or limit cardiovascular complications in young adults with youth-onset diabetes.

Funding

Grant Support (SEARCH 4): The SEARCH for Diabetes in Youth Cohort Study (1R01DK127208-01, 1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention. The Population Based Registry of Diabetes in Youth Study (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, and U18DP006139) is funded by the Centers for Disease Control and Prevention (DP-15-002) and supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Grant Support (SEARCH 1, 2, 3): SEARCH for Diabetes in Youth is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Kaiser Permanente Southern California (U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Cincinnati's Children's Hospital Medical Center (U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children's Hospital (U58/CCU019235-4, U01 DP000244, and U18DP002710-01] and Wake Forest University School of Medicine (U48/CCU919219, U01 DP000250, and 200-2010-35171).

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