title: Obesity is a determinant of arterial stiffness independent of traditional risk factors in Asians with young-onset type 2 diabetes.
abstract: OBJECTIVE
  Type 2 diabetes (T2DM) among the young population has become a serious concern globally, presumably due to the rising trend of obesity. Compared to other forms of diabetes, young-onset T2DM experiences more cardiovascular events and other vascular complications although the underlying mechanisms remain largely unknown. Increased arterial stiffness is a hallmark of vasculopathy. We aim to study the clinical and metabolic determinants of arterial stiffness in a cohort of multi-ethnic Asians with young-onset T2DM.
  
  
  METHODS
  179 subjects with T2DM onset age below 30 years old were selected in this cross sectional study. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV).
  
  
  RESULTS
  PWV was correlated with age, duration of diabetes, systolic blood pressure, alanine aminotransferase, urinary albumin-to-creatinine ratio (ACR) and eGFR in bivariate correlation analysis. However, PWV was only significantly correlated with body mass index (BMI), waist circumference, urinary ACR and eGFR after adjustment for age. Overweight individuals with young-onset T2DM had significantly higher PWV levels compared to their lean counterparts (7.3 ± 2.4 m/s vs 6.4 ± 2.3 m/s, p = 0.072 and p < 0.0001 without and with adjustment for age, respectively). Multivariable regression models revealed that age, BMI, eGFR and usage of insulin were independently associated with PWV. These 4 variables explained 35.5% variance in PWV levels.
  
  
  CONCLUSIONS
  Age, BMI, renal function and insulin usage are the main determinants of PWV levels in Asians with young-onset T2DM. Notably, obesity is a modifiable determinant of arterial stiffness independent of high blood pressure, dyslipidemia and hyperglycemia in this population.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Tavintharan
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Lee Ying
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Xiao Wei
authors.initials: XW
authors.lastname: Ng
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Angela Mei Chung
authors.initials: AM
authors.lastname: Moh
authors.affiliation: Yishun Polyclinic, National Health Group, Singapore 768796, Republic of Singapore.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Yishun Polyclinic, National Health Group, Singapore 768796, Republic of Singapore.
authors.forename: Wern Ee
authors.initials: WE
authors.lastname: Tang
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore. Electronic address: lim.su.chi@alexandrahealth.com.sg.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
mesh_terms: D000328:Adult; D017668:Age of Onset; D000410:Alanine Transaminase / Q000097:blood; D000419:Albuminuria / Q000453:epidemiology; D044466:Asian People / Q000706:statistics & numerical data*; D001794:Blood Pressure; D015992:Body Mass Index; D015897:Comorbidity; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007194:India / Q000208:ethnology; D007328:Insulin / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008296:Malaysia / Q000208:ethnology; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D059289:Vascular Stiffness; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D003404:Creatinine; D000410:Alanine Transaminase
keywords: Arterial stiffness; Cardiovascular risk; Obesity; Pulse wave velocity; Young-onset type 2 diabetes