Bell Ronny A, Rigdon Joseph, Bellatorre Anna, Dabelea Dana, D'Agostino Ralph, Divers Jasmin, Dolan Lawrence M, Jensen Elizabeth, Liese Angela D, Lustigova Eva, Marcovina Santica M, Merjaneh Lina, Pettitt David J, Pihoker Catherine, Shah Amy S, South Andrew M, Wagenknecht Lynne E
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Pediatr Diabetes. 2024 Jul 11;2024:5213520. doi: 10.1155/2024/5213520. eCollection 2024.
Cardiovascular disease (CVD) is the leading cause of death and disability among persons with diabetes. Early intervention on cardiovascular risk factors (CRFs) is important in reducing CVD burden. The SEARCH for Diabetes in Youth study assessed CRFs in incident cohorts of youth aged <20 years established from 2002 to 2016. . Regression models assessed trends over each incident year for lipids (total cholesterol (TC), HDL-c, LDL-c, triglycerides (TG), VLDL-c, and non-HDL-c), kidney function (albumin/creatinine ratio (ACR) ≥30 and ≥300, cystatin C, serum creatinine and estimated glomerular filtration rate (eGFR)), systolic and diastolic blood pressure (BP) -scores, BMI -score, waist circumference (WC), and an inflammatory marker (C-reactive protein (CRP)). Models were stratified by diabetes type (type 1 diabetes (T1D), = 4,600; type 2 diabetes (T2D), = 932) and adjusted for age at diagnosis, sex, race/ethnicity, and diabetes duration. An interaction analysis assessed differential time trends by type.
For youth with T1D, all CRFs significantly improved over time, with the exception of ACR > 300, cystatin C, serum creatinine, eGFR, and CRP. For youth with T2D, TC, LDL-c, and non-HDL-c significantly improved, while eGFR, BMI -score, and CRP significantly worsened. Significant differences in trends over time by type were seen for TC, HDL-c, BMI -score, BP -scores, WC, and CRP.
Overall, improvements in CRFs were more often observed in youth with T1D. Youth with T2D had worsening trends over time in BMI -score, CRP, and kidney function. Further research is needed to better understand these trends and their implications for long-term CVD risk.
心血管疾病（CVD）是糖尿病患者死亡和致残的主要原因。对心血管危险因素（CRF）进行早期干预对于减轻CVD负担至关重要。“青少年糖尿病SEARCH研究”评估了2002年至2016年建立的年龄小于20岁的新发青少年队列中的CRF。回归模型评估了各发病年份血脂（总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、甘油三酯（TG）、极低密度脂蛋白胆固醇（VLDL-c）和非高密度脂蛋白胆固醇（non-HDL-c））、肾功能（白蛋白/肌酐比值（ACR）≥30和≥300、胱抑素C、血清肌酐和估计肾小球滤过率（eGFR））、收缩压和舒张压（BP）评分、BMI评分、腰围（WC）以及一种炎症标志物（C反应蛋白（CRP））的变化趋势。模型按糖尿病类型（1型糖尿病（T1D），n = 4600；2型糖尿病（T2D），n = 932）分层，并根据诊断时的年龄、性别、种族/族裔和糖尿病病程进行调整。交互分析评估了不同类型之间的差异时间趋势。
对于T1D青少年，除ACR>300、胱抑素C、血清肌酐、eGFR和CRP外，所有CRF均随时间显著改善。对于T2D青少年，TC、LDL-c和non-HDL-c显著改善，而eGFR、BMI评分和CRP显著恶化。在TC、HDL-c、BMI评分、BP评分、WC和CRP方面，不同类型之间随时间的趋势存在显著差异。
总体而言，T1D青少年中CRF改善更为常见。T2D青少年的BMI评分、CRP和肾功能随时间呈恶化趋势。需要进一步研究以更好地理解这些趋势及其对长期CVD风险的影响。
