Longitudinal determinants of cardiovascular risk in Australian and New Zealand youth with type 1 diabetes: The ADDN study

Abstract

Primary aim was to measure the impact of BMI in youth with type 1 diabetes on cardiovascular risk factors. We also identified other independent determinants of risk. Methods: Inclusion criteria were youth with type 1 diabetes followed by the Australasian Diabetes Data Network (ADDN), aged 2 -25 years at all visits, with at least (i) two measures of BMI (ii)two measures of blood pressure at rest and/or (iii) one measure of total and HDL cholesterol. Exclusion criteria were anti- hypertensive or statin medications. A two way random intercept model was fitted at the patient and centre level, and a random slope for BMI z-score. Outcomes in multivariate analyses were blood pressure z-score, non -HDL cholesterol, and urinary albumin/creatinine. Results: An increase of 1 BMI z-score related independently to an increase in systolic (coefficient +0.26, 95% CI 0.24, 0.28, p< 0.001) and diastolic blood pressure z-scores (+0.13, 95% CI 0.11,0.14, p< 0.001) and higher non- HDL cholesterol (+0.16 mmol/L, 95% CI 0.13, 0.18, p< 0.001) and LDL cholesterol. Females had higher non -HDL cholesterol (coeff + 0.27 mmol/L, 95% CI 0.24- 0.31, p< 0.001) and higher ACR (coeff+0.63 mg/mmol, 95% CI 0.40, 0.86, p< 0.001). Indigenous Australians (1.8%) had higher non- HDL cholesterol (+0.21 mmol/L, 95% CI 0.04, 0.39, p=0.02) and markedly higher ACR (+ 2.37 mg/mmol, 95% CI 1.47, 3.27, p< 0.001). CSII participants had lower systolic and diastolic blood pressure z-scores (p< 0.001), lower ACR (-0.29 mg/mmol, 95%CI -0.53, -0.05, p< 0.001) and lower non-HDL cholesterol (-0.07mM, 95% CI-0.10,-0.03, p< 0.001), compared with MDI and independent of HbA1c's effect on non-HDL cholesterol (+0.13 mmol/L, 95% CI 0.12-0.14, p< 0.001). Conclusion: BMI had an independent adverse effect on cardiovascular risk. CSII had a modest independent benefit on cardiovascular risk profile. Females and indigenous Australians in particular had a more adverse risk profile.L6318876772020-06-02 <br />