A cross sectional study to compare cardiac structure and diastolic function in adolescents and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study

Abstract

Aims: To compare left ventricular structure (LV) and diastolic function in young adults with youth- onset diabetes by type, determine the prevalence of abnormal diastolic function by diabetes type using published values from age similar healthy controls, and examine the risk factors associated with diastolic function.

Methods: In a cross sectional analysis we compared LV structure and diastolic function from two dimensional echocardiogram in participants with type 1 (T1D) and type 2 diabetes (T2D) who participated in the SEARCH for Diabetes in Youth Study. Linear models were used to examine the risk factors associated with worse diastolic function.

Results: Of 479 participants studied, 258 had T1D (mean age 21.2 ± 5.2 years, 60.5% non-Hispanic white, 53.9% female) and 221 had T2D (mean age 24.8 ± 4.3 years, 24.4% non-Hispanic white, 73.8% female). Median diabetes duration was 11.6 years. Participants with T2D had greater LV mass index and worse diastolic function that persisted after adjustment for differences in risk factors compared with participants with T1D (all p < 0.05). Abnormal diastolic function, quantified using healthy controls, was pronounced in both groups but greater in those with T2D than T1D (T2D: 57.7% vs T1D: 47.2%, respectively), p < 0.05. Risk factors associated with worse diastolic function included older age at diabetes diagnosis, female sex, higher BP, heart rate and HbA1c and longer diabetes duration.

Conclusions: LV structure and diastolic function is worse in individuals with T2D compared to T1D. However, abnormal diastolic function in seen in both groups compared to published values from age similar healthy controls.

Keywords: Cardiac structure; Diastolic function; Pediatrics; Type 1 diabetes; Type 2 diabetes; Young adults.

Fig. 1

Left Ventricular Geometry and Diastolic Function by Diabetes Type. A. Distribution of Left Ventricular Geometry by Diabetes Type. Participants with type 1 and type 2 diabetes were stratified into four groups according to the LV mass cutoff > 51 g/m^2.7 and relative wall thickness (RWT) cutoff of > 0.41: A Normal geometry (white), b concentric remodeling (increased RWT only, light gray), c eccentric hypertrophy (increased LVM only, dark gray), and d concentric hypertrophy (both increased LVM and RWT, black). p value difference between groups was < 0.0001. B Prevalence of Abnormal Diastolic Function by Diabetes Type. Diastolic function was compared to data from age similar healthy controls to assess the percent of abnormal diastolic function in participants with type 1 diabetes and type 2 diabetes [32, 33]