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Influence of Duration of Diabetes, Glycemic Control, and Traditional Cardiovascular Risk Factors on Early Atherosclerotic Vascular Changes in Adolescents and Young Adults with Type 2 Diabetes Mellitus

Cincinnati Children’s Hospital Medical Center, Divisions of Endocrinology (A.S.S., L.M.D.) and Cardiology (T.R.K., Z.G., P.R.K., E.M.U.), Cincinnati, Ohio 45229; and University of Colorado Denver School of Medicine (S.R.D.), Division of Cardiology, Denver, Colorado 80262

Address all correspondence and requests for reprints to: Amy S. Shah, M.D., Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7012, Cincinnati, Ohio 45229. E-mail: amy.shah{at}cchmc.org.

Background: Carotid intima-media thickness (IMT) provides a mechanism for detecting early atherosclerosis. Little information is available concerning carotid IMT and the progression of atherosclerosis in adolescents and young adults with type 2 diabetes mellitus.

Objective: We sought to determine the factors that contribute to early changes in carotid IMT in youth with type 2 diabetes mellitus and to identify any predictors of increased carotid IMT.

Methods: Demographic, anthropometric, laboratory data and carotid imaging were obtained in 129 youth of mixed ethnicity, ages 10–23 yr. Associations of carotid IMT outcomes and risk variables were analyzed by regression analysis. Logistic regression was performed to elucidate independent determinants that predict a worse carotid IMT.

Results: Carotid IMT increased with higher glycosylated hemoglobin (HbA1c) levels and longer duration of diabetes. Regression modeling showed that HbA1c and duration of diabetes in the presence of traditional cardiovascular risk factors (male sex, LDL cholesterol, and blood pressure) were independent determinants of carotid IMT. Logistic regression analysis demonstrated that each 1% increase in HbA1c or each year increase in duration of type 2 diabetes mellitus is associated with approximately 30% increased odds of a thicker carotid IMT.

Conclusions: Poorer glycemic control and longer disease duration have independent adverse effects on carotid IMT in youth with type 2 diabetes mellitus. These adverse effects appear to be more prominent in males. Developing effective strategies to improve blood glucose control in youth with type 2 diabetes mellitus is essential to prevent or limit the development and progression of atherosclerotic cardiovascular disease.