Original Article
Early onset of subclinical atherosclerosis in young persons with type 1 diabetes

https://doi.org/10.1016/j.jpeds.2004.06.042Get rights and content

Objective

To evaluate the degree of atherosclerosis and its risk factors in adolescents and young adults with type 1 diabetes.

Study design

We measured carotid artery intima-media thickness (IMT) in 142 subjects with type 1 diabetes (mean [SD] age = 16.0 [2.6] years) and 87 control subjects (18.8 [3.1] years). Fasting lipid and homocysteine levels, degree of glycemic control, blood pressure, and body mass index were measured in persons with diabetes.

Results

The mean carotid IMT was greater in persons with diabetes (P = .002). Among subjects with type 1 diabetes, lipid levels were significantly higher in female subjects compared with male subjects. The mean carotid IMT was significantly higher in persons with a diabetic complication (including hypertension, retinopathy, or microalbuminuria). In male subjects but not female subjects, HDL cholesterol and the LDL/HDL ratio were correlated with carotid IMT.

Conclusions

Adolescents with type 1 diabetes have increased atherosclerosis compared with control subjects. Risk factors for increased carotid IMT in these younger patients include diabetic complications and HDL cholesterol and the LDL/HDL ratio, which may be sex-specific.

Section snippets

Study population

Subjects (63 male, 79 female) 12 to 25 years of age, with type 1 diabetes defined by American Diabetes Association criteria, were recruited as a sample of convenience from the clinic population at the Children's Hospital Los Angeles Comprehensive Diabetes Center (CCDC). Eighty-seven subjects (35 male, 52 female) 12 to 25 years of age, without diabetes, were recruited for evaluation of carotid IMT only. Subjects were excluded if they had evidence or history of clinically relevant systemic

Results

Subjects without diabetes were significantly older than those with diabetes (mean [SD] = 18.8 [3.1] vs 16.0 [2.6] years, P < .001). The sample of subjects without diabetes included 35 (40%) male subjects, and the sample of subjects with diabetes included 63 (44%) male subjects (P = .54). The overall ethnic distribution was 37% white, 56% Hispanic, 4% black, and 3% other (P = .45 between groups).

Subjects with diabetes had significantly elevated age-adjusted carotid artery IMT compared with subjects

Discussion

Although they were somewhat younger than our nondiabetic sample, young persons with type 1 diabetes had increased carotid IMT relative to young persons without diabetes. Our findings support previous work regarding the early onset of atherosclerosis in adolescents and young adults with diabetes8., 9., 26., 27. and is in contrast to others who have not found a difference in carotid IMT in younger patients (3 to 18 years of age) with type 1 diabetes.28 Despite the added burden of diabetes on

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    Supported by a grant from the American Diabetes Association.

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