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Dr Stephanie Jones, Dr Amal Khanolkar, Dr Krystyna Matyka,
Development of cardiovascular risk factors in children with type 1 diabetes A longitudinal cohort study Dr Stephanie Jones, Dr Amal Khanolkar, Dr Krystyna Matyka, Dr Evelien Gevers, Dr Jeremy Allgrove, Prof Terence Stephenson, Dr Rakesh Amin
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BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in adults with diabetes Atherosclerosis begins in childhood and progression correlates to modifiable risk factors: Incidence of CVD varies between ethnicities Obesity Hypertension Dyslipidaemia Poor diet Reduced Exercise Psychosocial factors Smoking Alcohol
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PROJECT AIMS: AIMS To understand the characteristics and prevalence of cardiovascular risk factors in a longitudinal cohort of children with Type 1 diabetes To understand the relationship of these risk factors with increasing disease duration To look for differences between ethnic groups
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METHODS Patient Sample Outcomes of Interest
Body Mass Index (BMI) Blood Pressure (BP) Lipids (Total cholesterol, LDL, HDL, triglycerides) All children diagnosed and attending routine clinics at Barts NHS Trust between (n = 565)
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METHODS Data Analysis Prospective collection
Comparisons made between covariates and age/ethnicity Longitudinal mixed effects models accounting for covariates were undertaken: Model 1: Diabetes Duration Model 2: Age Gender Ethnicity Diabetes Clinic Model 3: HbA1c Model 4: Height (BP only)
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Patients PATIENTS Mean age at diagnosis 8.5 years (0.6 - 19.4)
Mean length of follow up 4.3 years ( ) 52% were boys 60% were non-White Mean HbA1c 70.8mmol/mol (8.6%) Average 4 contacts/year (1-14) BMI BP Lipid N (%) 535 (94.7) 463 (82) 377 (66.7) Mean age in years at first measure [SD] 9.3 [4.3] 9.9 [4.2] * 10.6 [4.3] * Measures/ year (range) 3 (1-9) 3 (1-8) 1 (1-3) * p<0.001 (variation between diabetes clinics)
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RESULTS At diagnosis: BMI Sys BP Dias BP T.chol LDL All 19.0 [3.8]
(kg/m2) (mmHg) (mmol/mol) All 19.0 [3.8] 106 [11] 61 [8] 4.2 [0.9] 2.3 [0.7] SDS 0.6 [1.1] -0.5 [1.1] 0.4 [0.9]
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RESULTS At diagnosis: BMI Sys BP Dias BP T.chol LDL All 19.0 [3.8]
(kg/m2) (mmHg) (mmol/mol) All 19.0 [3.8] 106 [11] 61 [8] 4.2 [0.9] 2.3 [0.7] White 19.1 [3.5] 62 [9] 4.2 [0.8] 2.2 [0.7] Mixed 18.2 [3.1] 104 [12] 59 [7] 4.2 [1.0] 2.4 [0.8] Somali 18.3 [3.6] 102 [11] 58 [5] 4.1 [0.9] 2.0 [0.6] Black Other 20.5* [3.9] 109 [10] 60 [6] 4.3 [1.0] 2.4 [0.7] Bangladeshi 20.5* [3.5] 2.5 [0.7] Asian Other 18.4 [4.4] 107 [13] 63 [10] 4.0 [0.9] 2.1 [0.8] * P <0.05, ** p <0.01
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RESULTS At follow up (4 years): BMI Sys BP Dias BP T.chol LDL All
(kg/m2) (mmHg) (mmol/mol) All 19.0 [3.8] 106 [11] 61 [8] 4.2 [0.9] 2.3 [0.7] White 19.1 [3.5] 62 [9] 4.2 [0.8] 2.2 [0.7] f/u Mixed 18.2 [3.1] 104 [12] 59 [7] 4.2 [1.0] 2.4 [0.8] Somali 18.3 [3.6] 102 [11] 58 [5] 4.1 [0.9] 2.0 [0.6] Black Other 20.5* [3.9] 109 [10] 60 [6] 4.3 [1.0] 2.4 [0.7] Bangladeshi 20.5* [3.5] 2.5 [0.7] Asian Other 18.4 [4.4] 107 [13] 63 [10] 4.0 [0.9] 2.1 [0.8] 19.9 [3.8] [0.7] 9.9 [4.6] [0.6] 16.9 [3.5]** [-] 21.8* [12.7] [1.3] 20.5 [3.7] * [0.9] 19.8 [3.8] [0.4] * P <0.05, ** p <0.01
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RESULTS Percentage of measurements above target values
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RESULTS – Longitudinal Models
Fully adjusted models demonstrated small annual increments with increasing diabetes duration* Lipids in keeping with large American cohort (Shah et al 2017) Subgroup (>12 years) analysis demonstrated similar results‡ HbA1c effected all variables other than BP* BMI (0.6 kg/m2) BP (2 mmHg / 0.07 SDS) T.chol (0.02 mmol/mol) LDL (0.02 mmol/mol) HDL (0.03 mmol/mol) ‡ NS, * p<0.001
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RESULTS – Longitudinal Models
There was significant variation between ethnicities: Black children had the greatest rise in BMIϮ (1.6 kg/m2) Bangladeshi children had the most clinically significant riseϮ (T.chol & LDL 0.3 mmol/mol) Ϯ p<0.01
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CONCLUSIONS This study identified high numbers of abnormal measures of modifiable risks for CVD in children with Type 1 Diabetes Most outcomes rose with increasing disease duration and is associated with poor glycaemic control. There were significant ethnic differences in the association between risk factors and disease duration
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RESULTS There was no significant difference between measures taken before or after 12 years * p <0.001
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BMI Sys BP Dias BP T.chol All
(kg/m2) (mmHg) (mmol/mol) All 19.7 [4.1] 110 [12] 64 [9] 4.3 [0.9] Boys 19.2 [3.5] 111 [12] 63 [8] Girls 20.1* [4.5] 110 [11] 64* [9] 4.4 [0.84] White 19.7 [4.0] 4.3 [0.8] Mixed 19.0* [3.5 107* [11] 62* [8] 4.2 [0.8] Somali 18.2* 3.6] 105 [11] 60* [8] 4.2 [0.9] Black Other 21.0* [3.9] 113* [12] Bangladeshi 20.3* [4.4] 109* [13] 4.8* [1.0] Asian Other 19.4 [4.2] 67* [10] Bold = p<0.05, * = p <0.001
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