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      A cross sectional study to compare cardiac structure and diastolic function in adolescents and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study

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          Abstract

          Aims

          To compare left ventricular structure (LV) and diastolic function in young adults with youth- onset diabetes by type, determine the prevalence of abnormal diastolic function by diabetes type using published values from age similar healthy controls, and examine the risk factors associated with diastolic function.

          Methods

          In a cross sectional analysis we compared LV structure and diastolic function from two dimensional echocardiogram in participants with type 1 (T1D) and type 2 diabetes (T2D) who participated in the SEARCH for Diabetes in Youth Study. Linear models were used to examine the risk factors associated with worse diastolic function.

          Results

          Of 479 participants studied, 258 had T1D (mean age 21.2 ± 5.2 years, 60.5% non-Hispanic white, 53.9% female) and 221 had T2D (mean age 24.8 ± 4.3 years, 24.4% non-Hispanic white, 73.8% female). Median diabetes duration was 11.6 years. Participants with T2D had greater LV mass index and worse diastolic function that persisted after adjustment for differences in risk factors compared with participants with T1D (all p < 0.05). Abnormal diastolic function, quantified using healthy controls, was pronounced in both groups but greater in those with T2D than T1D (T2D: 57.7% vs T1D: 47.2%, respectively), p < 0.05. Risk factors associated with worse diastolic function included older age at diabetes diagnosis, female sex, higher BP, heart rate and HbA1c and longer diabetes duration.

          Conclusions

          LV structure and diastolic function is worse in individuals with T2D compared to T1D. However, abnormal diastolic function in seen in both groups compared to published values from age similar healthy controls.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12933-021-01328-0.

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          Most cited references39

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          Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

          These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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            Diabetes and cardiovascular disease. The Framingham study.

            Based on 20 years of surveillance of the Framingham cohort relating subsequent cardiovascular events to prior evidence of diabetes, a twofold to threefold increased risk of clinical atherosclerotic disease was reported. The relative impact was greatest for intermittent claudication (IC) and congestive heart failure (CHF) and least for coronary heart disease (CHD), which was, nevertheless, on an absolute scale the chief sequela. The relative impact was substantially greater for women than for men. For each of the cardiovascular diseases (CVD), morbidity and mortality were higher for diabetic women than for nondiabetic men. After adjustment for other associated risk factors, the relative impact of diabetes on CHD, IC, or stroke incidence was the same for women as for men; for CVD death and CHF, it was greater for women. Cardiovascular mortality was actually about as great for diabetic women as for diabetic men.
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              Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012

              Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden. The prevalence of these diseases increased in the 2001-2009 period, but data on recent incidence trends are lacking.
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                Author and article information

                Contributors
                Amy.shah@cchmc.org
                Journal
                Cardiovasc Diabetol
                Cardiovasc Diabetol
                Cardiovascular Diabetology
                BioMed Central (London )
                1475-2840
                7 July 2021
                7 July 2021
                2021
                : 20
                : 136
                Affiliations
                [1 ]GRID grid.239573.9, ISNI 0000 0000 9025 8099, Department of Pediatrics, Division of Endocrinology, , Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, ; 3333 Burnet Ave ML 7012, Cincinnati, OH 45229 USA
                [2 ]GRID grid.241167.7, ISNI 0000 0001 2185 3318, Department of Biostatistics and Data Science, , Wake Forest School of Medicine, ; Winston-Salem, USA
                [3 ]GRID grid.430503.1, ISNI 0000 0001 0703 675X, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, , University of Colorado Anschutz Medical Campus (CU-Anschutz), ; Aurora, USA
                [4 ]GRID grid.416738.f, ISNI 0000 0001 2163 0069, Division of Diabetes Translation, Centers for Disease Control and Prevention, ; Atlanta, USA
                [5 ]GRID grid.254567.7, ISNI 0000 0000 9075 106X, Department of Epidemiology and Biostatistics, Arnold School of Public Health, , University of South Carolina, ; Columbia, USA
                [6 ]Department of Research & Evaluation, Kaiser Permanente Southern California, Los Angeles, USA
                [7 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Pediatrics, , The University of Washington, ; Washington, USA
                Author information
                http://orcid.org/0000-0001-7297-139X
                Article
                1328
                10.1186/s12933-021-01328-0
                8265135
                34233679
                f952663a-1172-405f-a3e3-2f481d425f7d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 May 2021
                : 29 June 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000062, National Institute of Diabetes and Digestive and Kidney Diseases;
                Funded by: FundRef http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
                Categories
                Original Investigation
                Custom metadata
                © The Author(s) 2021

                Endocrinology & Diabetes
                type 1 diabetes,type 2 diabetes,cardiac structure,diastolic function,pediatrics,young adults

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