Cardiovascular Disease Already a Factor for Teens With Type 1 Diabetes

June 16, 2005

Bonnie Darves

June 16, 2005 (San Diego) -- Artery walls begin thickening as early as the midteen years in young people with type 1 diabetes, and early atherosclerosis is more pronounced in teen boys than in girls and also in teens who smoke or have relatively high total cholesterol and apolipoprotein B levels, according to a study presented here at the American Diabetes Association's 65th Annual Scientific Sessions.

These findings suggest that if poor glucose control is also a factor in teens with type 1 diabetes, the early arterial thickening may translate into diabetes complications earlier than previously thought.

What that means for clinicians who treat this population is that early intensive management, coupled with aggressive risk-reduction counseling, may be in order, said study author Francine Kaufman, MD, head of the division of endocrinology and metabolism at Children's Hospital Los Angeles, Los Angeles, California. "Pediatricians are already aware of glycemic control importance with these children, but now what we wonder is whether cardiovascular disease might be developing earlier than we thought," Dr. Kaufman said. "We need further studies to determine whether some of this dyslipidemia is meaningful at this age and whether it should be treated because we might not be able to just come in and fix everything later, at [age] 40."

To assess the presence of atherosclerosis, investigators measured the intima-media thickness (IMT) of the common carotid artery, which is considered an early marker of atherosclerosis. In their study of 90 teenaged boys and girls diagnosed as having type 1 diabetes, researchers compared the IMT measurements of those with diabetes vs those of 16 teens who did not have diabetes. Among the diabetes and control groups, the mean age was 16 years, and the mean body mass index was 23 kg/m 2 for the diabetes group and 25 kg/m 2 for controls. Those with diabetes were approximately 7.8 years postdiagnosis. The mean hemoglobin A1C level was 8.4% for both groups.

On performing IMT testing, the researchers found that teen boys with type 1 diabetes had significantly higher IMT than either teen girls with type 1 diabetes or the control group (males, 0.582 vs 0.524 (control); girls, 0.548 vs 0.556 (control), respectively). IMT was also relatively higher in teen boys with diabetes who smoked or who were frequently exposed to second-hand smoke than in their nonsmoking counterparts.

The finding that IMT was worse in the boys than in the girls studied suggests that there may be a "gender benefit," Dr. Kaufman said. "But what we do not know is whether that gender benefit will persist when those teens reach their twenties."

Charles Gegick, MD, an endocrinologist in Greensboro, North Carolina concurs. Dr. Gegick said that clinicians who treat young people with diabetes should engage in proactive management "that focuses not only on A1C reduction but also on short-term goals such as blood pressure reduction, lifestyle factors, and weight loss and measures [that] progress toward meeting those goals. It is not effective or meaningful to this population to talk about what might happen 20 years down the road."

Since it is difficult to attain good glucose control during puberty in teens who have type 1 diabetes, "it may be easier to treat those [cardiovascular and lipid] problems than to control blood sugar," Dr. Kaufman said. She noted that while physicians can and do prescribe drugs to treat hypertension in this age group, the concept of treating lipid abnormalities has not been explored. Dr. Kaufman and colleagues are now conducting a randomized, placebo-controlled study of teens with type 1 diabetes to determine whether treating lipid abnormalities affects IMT.

ADA 65th Annual Scientific Sessions: Abstract 261-OR. Presented June 13, 2005.

Reviewed by Gary D. Vogin, MD

Bonnie Darves is a freelance writer for Medscape.

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