Department of Pediatrics, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH.
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC.
Diabetes Care. 2022 Jul 7;45(7):1647-1656. doi: 10.2337/dc21-2426.
We compared arterial stiffness and heart rate variability (HRV) over time by diabetes type and determined the risk factors associated with worsening arterial stiffness and HRV in young adults with youth-onset diabetes.
Arterial stiffness (pulse wave velocity, augmentation index) and six indices of heart rate variability were measured twice, 4.5 years apart, among participants with either youth-onset type 1 or type 2 diabetes in the SEARCH for Diabetes in Youth study. Multivariable linear regression models were used to assess risk factors associated with arterial stiffness and HRV at follow-up.
Of 1,159 participants studied, 949 had type 1 diabetes (mean age 17.1 ± 4.7 years, 60.3% non-Hispanic White, 55% female) and 210 had type 2 diabetes (mean age 22.1 ± 3.5 years, 23.8% non-Hispanic White, 71% female) at initial assessment when diabetes duration was 7.9 years (both groups). Participants with type 2 versus type 1 diabetes had greater arterial stiffness and more abnormalities in HRV at initial and follow-up assessment and a greater change over time (all P < 0.05). Risk factors associated with worse arterial stiffness and HRV at follow-up in both types of diabetes included higher blood pressure, hemoglobin A1c, waist circumference, and triglycerides over time and longer diabetes duration.
Arterial stiffness and HRV worsened over time with greater changes among participants with type 2 versus type 1 diabetes and among those with features of the metabolic syndrome. The risk factor profile documents potentially modifiable pathways to prevent or limit cardiovascular complications in young adults with youth-onset diabetes.
通过糖尿病类型比较动脉僵硬度和心率变异性（HRV）随时间的变化，并确定青年发病糖尿病患者动脉僵硬度和 HRV 恶化的相关危险因素。
在 SEARCH for Diabetes in Youth 研究中，对患有青年发病 1 型或 2 型糖尿病的参与者，在相隔 4.5 年的时间内两次测量动脉僵硬度（脉搏波速度、增强指数）和心率变异性的六个指标。采用多元线性回归模型评估随访时与动脉僵硬度和 HRV 相关的危险因素。
在 1159 名研究对象中，949 名患有 1 型糖尿病（平均年龄 17.1 ± 4.7 岁，60.3%非西班牙裔白人，55%女性），210 名患有 2 型糖尿病（平均年龄 22.1 ± 3.5 岁，23.8%非西班牙裔白人，71%女性），在糖尿病病程为 7.9 年时（两组）进行初始评估。与 1 型糖尿病相比，2 型糖尿病患者的动脉僵硬度更大，HRV 异常更多，且随时间的变化更大（均 P < 0.05）。在两种类型的糖尿病中，与随访时动脉僵硬度和 HRV 恶化相关的危险因素包括随时间升高的血压、糖化血红蛋白、腰围和甘油三酯以及更长的糖尿病病程。
随着时间的推移，动脉僵硬度和 HRV 逐渐恶化，2 型糖尿病患者的变化幅度大于 1 型糖尿病患者，且代谢综合征特征患者的变化幅度更大。风险因素谱记录了可能可改变的途径，以预防或限制青年发病糖尿病患者的心血管并发症。
