Bjornstad Petter, Pyle Laura, Nguyen Nhung, Snell-Bergeon Janet K, Bishop Franziska K, Wadwa R Paul, Maahs David M
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Diabetes. 2015 Feb;16(1):22-30. doi: 10.1111/pedi.12252.
Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for hemoglobin A1c (HbA1c), blood pressure (BP), lipids, and body mass index (BMI). We hypothesized that ISPAD/ADA goal achievement at baseline would be associated with cardiorenal risk factors at baseline and 2 yr follow-up in adolescents with type 1 diabetes.
We assessed the cross-sectional and longitudinal relationships between ISPAD/ADA goal achievement at baseline and cardiorenal health at baseline and 2-yr follow-up (n = 297; 15.4 ± 2.1 yr at baseline) in adolescents with type 1 diabetes. Goal achievement was defined as HbA1c < 7.5%, BP < 90th percentile for age, sex, and height, low density lipoprotein-cholesterol (LDL-C) <100 mg/dL, high density lipoprotein-cholesterol (HDL-C) >35 mg/dL, triglycerides (TG) <150 mg/dL and BMI <85th percentile for age and sex. Cardiorenal outcomes included pulse-wave velocity (PWV), brachial distensibility (BrachD), augmentation index (AIx), and epidermal growth factor receptor (eGFR) continuously and categorically as hyperfiltration (eGFR ≥ 135 mL/min/1.73 m(2)).
Adolescents with type 1 diabetes who met 1-3 goals, had significantly greater (P < 0.05) baseline PWV (5.1 ± 0.1 vs. 5.4 ± 0.1 m/s), follow-up PWV (5.5 ± 0.1 vs. 5.7 ± 0.1 m/s), greater follow-up eGFR (104 ± 2 vs. 116 ± 3 mL/min/1.73 m(2)), and greater odds of renal hyperfiltration at follow-up (odds ratio (OR): 20.0, 95% confidence interval (CI): 3.8-105.2) compared to those who met 4-6 goals after adjusting for Tanner stage, sex, age, and diabetes duration. No statistically significant differences in the cardiorenal outcomes were observed between adolescents with type 1 diabetes who met 4-6 goals and non-diabetic controls (n = 96).
In adolescents with type 1 diabetes, baseline ADA/ISPAD goal achievement was associated with cardiorenal protection at baseline and 2-yr follow-up.
大多数1型糖尿病青少年未达到美国糖尿病协会（ADA）和国际儿童及青少年糖尿病学会（ISPAD）关于糖化血红蛋白（HbA1c）、血压（BP）、血脂和体重指数（BMI）的目标。我们假设，1型糖尿病青少年在基线时达到ISPAD/ADA目标与基线及2年随访时的心脏肾脏危险因素相关。
我们评估了1型糖尿病青少年在基线时达到ISPAD/ADA目标与基线及2年随访时（n = 297；基线时年龄15.4±2.1岁）心脏肾脏健康之间的横断面和纵向关系。目标达成定义为HbA1c<7.5%、血压低于年龄、性别和身高对应的第90百分位数、低密度脂蛋白胆固醇（LDL-C）<100mg/dL、高密度脂蛋白胆固醇（HDL-C）>35mg/dL、甘油三酯（TG）<150mg/dL以及BMI低于年龄和性别的第85百分位数。心脏肾脏结局包括脉搏波速度（PWV）、肱动脉扩张性（BrachD）、增强指数（AIx）以及表皮生长因子受体（eGFR），并将eGFR持续和分类为超滤（eGFR≥135mL/min/1.73m²）。
与达到4 - 6项目标的青少年相比，在调整了坦纳分期、性别、年龄和糖尿病病程后，达到1 - 3项目标的1型糖尿病青少年基线PWV显著更高（5.1±0.1对5.4±0.1m/s）、随访PWV更高（5.5±0.1对5.7±0.1m/s）、随访eGFR更高（104±2对116±3mL/min/1.73m²），且随访时肾脏超滤的几率更高（优势比（OR）：20.0，95%置信区间（CI）：3.8 - 105.2）。达到4 - 6项目标的1型糖尿病青少年与非糖尿病对照组（n = 96）之间在心脏肾脏结局方面未观察到统计学显著差异。
在1型糖尿病青少年中，基线时达到ADA/ISPAD目标与基线及2年随访时的心脏肾脏保护相关。
