Cardiovascular risk factors in children and adolescents with type 1 diabetes in Italy: a multicentric observational study.
adolescents
cardiovascular risk
cardiovascular risk factors
children
type 1 diabetes
Journal
Pediatric diabetes
ISSN: 1399-5448
Titre abrégé: Pediatr Diabetes
Pays: Denmark
ID NLM: 100939345
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
07
05
2020
revised:
27
07
2020
accepted:
28
08
2020
pubmed:
18
9
2020
medline:
1
10
2021
entrez:
17
9
2020
Statut:
ppublish
Résumé
To assess the prevalence of cardiovascular risk factors (CVRFs) and to identify the variables associated with CVRFs in a cohort of children and adolescents with Type 1 Diabetes. 2021 subjects, 2-18 year-old, were recruited in 17 Italian Pediatric Diabetes Centers. Anthropometric, blood pressure, biochemical (HbA1c, lipid profile, ACR), insulin therapy, physical activity level, smoking and family socio-economic status data were collected. CVRFs prevalence and their distribution were analyzed according to age and binary logistic regression was performed with positivity for at least one major CVRF (BMI-SDS > +2SD, blood pressure > 90th percentile, LDL cholesterol>100 mg/dL) as dependent variable and age, duration of illness, gender, HbA1c and physical activity, as independent variables. The prevalence of CVFRs not at the recommended target was respectively: 32.5% one CVRF, 6.7% two CVRFs and 0.6% three CVRFs, with no significant differences across the 3 age groups (2-10, 10-15, 15-18 years). In the total sample, HbA1c and inadequate physical activity were associated with a higher probability of having at least one major CVRF. This probability was associated with physical activity in the 2-10-year-old group, with physical activity and HbA1c in the 10-15-year-old group and with HbA1c only in subjects older than 15 years. More than 30% of subjects had at least a major CVRF. Early detection of CVRFs may be useful to enforce the therapeutic intervention in this subgroup, in order to reduce the risk to develop cardiovascular complications.
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1546-1555Informations de copyright
© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.
Références
Rawshani A, Rawshani A, Gudbjörnsdottir S. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017;377(3):300-301.
Järvisalo MJ, Raitakari M, Toikka JO, et al. Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes. Circulation. 2004;109(14):1750-1755.
Donaghue KC, Marcovecchio ML, Wadwa RP, et al. ISPAD clinical practice consensus guidelines 2018: microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes. 2018;19(Suppl 27):262-274.
American Diabetes Association. 13. Children and adolescents: standards of medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S163-S182.
Maahs DM, Daniels SR, de Ferranti SD, et al. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation. 2014;130(17):1532-1558.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5):S213-S256.
Lind M, Bounias I, OlssonM GS, Svensson AM, Rosengren A. Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study. Lancet. 2011;378(9786):140-146.
Lind M, Svensson AM, Kosiborod M, et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014;371(21):1972-1982.
Weis U, Turner B, Gibney J, et al. Long-term predictors of coronary artery disease and mortality in type 1 diabetes. QJM. 2001;94(11):623-630.
Kershnar AK, Daniels SR, Imperatore G, et al. Lipid abnormalities are prevalent in youth with type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. J Pediatr. 2006;149(3):314-319.
Guy J, Ogden L, Wadwa RP, et al. Lipid and lipoprotein profiles in youth with and without type 1 diabetes: the SEARCH for diabetes in youth case-control study. Diabetes Care. 2009;32(3):416-420.
Maffeis C, Birkebaek NH, Konstantinova M, et al. Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: data from the international SWEET registry. Pediatr Diabetes. 2018;19(7):1211-1220.
Juonala M, Magnussen CG, Berenson GS, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365(20):1876-1885.
Park MH, Falconer C, Viner RM, Kinra S. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev. 2012;13(11):985-1000.
Valerio G, Iafusco D, Zucchini S, Maffeis C, Study-Group on Diabetes of Italian Society of Pediatric Endocrinology and Diabetology (ISPED). Abdominal adiposity and cardiovascular risk factors in adolescents with type 1 diabetes. Diabetes Res Clin Pract. 2012;97(1):99-104.
Mäkinen VP, Forsblom C, Thorn LM, et al. Metabolic phenotypes, vascular complications, and premature deaths in a population of 4,197 patients with type 1 diabetes. Diabetes. 2008;57(9):2480-2487.
Urbina EM, Dabelea D, D'Agostino RB Jr, et al. Effect of type 1 diabetes on carotid structure and function in adolescents and young adults: the SEARCH CVD study. Diabetes Care. 2013;36(9):2597-2599.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. The multiple risk factor intervention trial research group. Diabetes, other risk factors, and 12-Yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993;16(2):434-444.
Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351(9118):1755-1762.
Donaghue K, Jeanne Wong SL. Traditional cardiovascular risk factors in adolescents with type 1 diabetes mellitus. Curr Diabetes Rev. 2017;13(6):533-543.
Kim Y, Wilkens LR, Park SY, Goodman MT, Monroe KR, Kolonel LN. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the multiethnic cohort study. Int J Epidemiol. 2013;42(4):1040-1056.
Herbst A, Kordonouri O, Schwab KO, Schmidt F, Holl RW, DPV Initiative of the German Working Group for Pediatric Diabetology Germany. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 23,251 patients. Diabetes Care. 2007;30(8):2098-2100.
Adolfsson P, Riddell MC, Taplin CE, et al. ISPAD clinical practice consensus guidelines 2018: exercise in children and adolescents with diabetes. Pediatr Diabetes. 2018;19(Suppl 27):205-226.
Jones S, Khanolkar AR, Gevers E, Stephenson T, Amin R. Cardiovascular risk factors from diagnosis in children with type 1 diabetes mellitus: a longitudinal cohort study. BMJ Open Diabetes Res Care. 2019;7(1):e000625.
Stankute I, Dobrovolskiene R, Danyte E, et al. Factors affecting cardiovascular risk in children, adolescents, and young adults with type 1 diabetes. J Diabetes Res. 2019;9134280.
Cree-Green M, Stuppy JJ, Thurston J, et al. Youth with type 1 diabetes have adipose, hepatic, and peripheral insulin resistance. J Clin Endocrinol Metab. 2018;103(10):3647-3657.
Schwab KO, Doerfer J, Hecker W, et al. DPV initiative of the German working Group for Pediatric Diabetology. Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care. 2006;29(2):218-225.
Maffeis C, Fornari E, Morandi A, et al. Glucose-independent association of adiposity and diet composition with cardiovascular risk in children and adolescents with type 1 diabetes. Acta Diabetol. 2017;54(6):599-605.
Valerio G, Mozzillo E, Zito E, et al. Alcohol consumption or cigarette smoking and cardiovascular disease risk in youth with type 1 diabetes. Acta Diabetol. 2019;56(12):1315-1321.
World Health Organization. Growth reference charts 2-5 and 5-19 years. http://www.who.int/childgrowth/standards/bmi_for_age/en/; www.who.int/growthref/who2007_bmi_for_age/en/. Accessed May 5, 2020.
Maffeis C, Grezzani A, Pietrobelli A, Provera S, Tatò L. Does waist circumference predict fat gain in children? Int J Obes Relat Metab Disord. 2001;25(7):978-983.
Maffeis C, Banzato C, Talamini G. Obesity study Group of the Italian Society of pediatric endocrinology and Diabetology. Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr. 2008;152(2):207-213.
Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and Management of High Blood Pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904.
Singh R, Pattisapu A, Emery MS. US physical activity guidelines: current state, impact and future directions. Trends Cardiovasc Med. 2020;30(7):407-412.
Montano D. Certifying leaders? High-quality management practices and healthy organisations: an ISO-9000 based standardisation approach. Ind Health. 2016;54(4):324-336.
Rao G. Diagnosis, epidemiology, and Management of Hypertension in children. Pediatrics. 2016;138(2):e20153616.
Margeirsdottir HD, Larsen JR, Brunborg C, Overby NC. Dahl-Jørgensen K; Norwegian study Group for Childhood Diabetes. High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia. 2008;51(4):554-561.
Martino F, Puddu PE, Pannarale G, et al. Arterial blood pressure and serum lipids in a population of children and adolescents from southern Italy: the Calabrian sierras community study (CSCS). Int J Cardiol. 2013;168(2):1108-1114.
Rawshani A, Sattar N, Franzén S, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392(10146):477-486.
Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement [published correction appears in lancet diabetes Endocrinol. 2017 may;5(5):e3]. Lancet Diabetes Endocrinol. 2017;5(5):377-390.
Tully C, Aronow L, Mackey E, Streisand R. Physical activity in youth with type 1 diabetes: a review. Curr Diab Rep. 2016;16(9):85.
Larsen J, Brekke M, Sandvik L, Arnesen H, Hanssen KF, Dahl-Jorgensen K. Silent coronary atheromatosis in type 1 diabetic patients and its relation to long-term glycemic control. Diabetes. 2002;51(8):2637-2641.
Niechciał E, Acerini CL, Chiesa ST, et al. Adolescent type 1 diabetes cardio-renal intervention trial (AdDIT) study group; adolescent type 1 diabetes cardio-renal intervention trial AdDIT study group. Medication adherence during adjunct therapy with statins and ACE inhibitors in adolescents with type 1 diabetes. Diabetes Care. 2020;43(5):1070-1076.
Snauwaert E, Vande Walle J, De Bruyne P. Therapeutic efficacy and safety of ACE inhibitors in the hypertensive paediatric population: a review. Arch Dis Child. 2017;102(1):63-71.
Canas JA, Ross JL, Taboada MV, et al. A randomized, double blind, placebo-controlled pilot trial of the safety and efficacy of atorvastatin in children with elevated low-density lipoprotein cholesterol (LDL-C) and type 1 diabetes. Pediatr Diabetes. 2015;16(2):79-89.
Nambam B, DuBose SN, Nathan BM, et al. T1D exchange clinic network. Therapeutic inertia: underdiagnosed and undertreated hypertension in children participating in the T1D exchange clinic registry. Pediatr Diabetes. 2016;17(1):15-20.
Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298(8):874-879.