Insulin sensitivity and arterial stiffness in youth with type 1 diabetes: the SEARCH CVD study.
OBJECTIVE
Decreased insulin sensitivity is a cardiovascular risk factor (CVRF) in youth with type 1 diabetes (T1D). Whether baseline insulin sensitivity is independently associated with changes in early arterial stiffness (pulse wave velocity (PWV)) over time in youth with T1D is not known.


METHODS
Two hundred ninety-eight youth with T1D in the SEARCH CVD study had PWV measured~five years apart. Insulin sensitivity and other CVRFs were measured at baseline. The association between baseline insulin sensitivity with PWV over time was explored using linear mixed models. Models were adjusted for baseline age, sex and race, with subsequent adjustment for CVRFs.


RESULTS
There was a significant interaction (p=0.0326) between baseline insulin sensitivity and time on PWV, independent of CVRFs, indicating that higher insulin sensitivity levels were associated with lower rate of change in PWV over time. Other significant predictors of PWV change were baseline age [β=0.007 (p=0.03) increase in logPWV/year increase in age] and mean arterial blood pressure (MAP) [β=0.005 (p<0.01) increase in logPWV/mmHg increase in MAP] and smoking status (current vs. never smoker).


CONCLUSIONS
Lower insulin sensitivity at baseline appears to be an important risk factor for increased arterial stiffness over time in youth with T1D. This identifies a potentially modifiable therapeutic target.
Cincinnati Children's Hospital, Cincinnati, OH USA. Electronic address: amy.shah@cchmc.org.
Amy S
AS
Shah
Colorado School of Public Health, Aurora, CO USA.
Sandra
S
Black
Barbara Davis Center for Childhood Diabetes, Aurora, CO USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO USA.
R Paul
RP
Wadwa
Colorado School of Public Health, Aurora, CO USA.
Sarah J
SJ
Schmiege
Wake Forest School of Medicine, Winston-Salem, NC USA.
Nora F
NF
Fino
Wake Forest School of Medicine, Winston-Salem, NC USA.
Jennifer W
JW
Talton
Wake Forest School of Medicine, Winston-Salem, NC USA.
Ralph
R
D'Agostino
Colorado School of Public Health, Aurora, CO USA.
Richard F
RF
Hamman
Cincinnati Children's Hospital, Cincinnati, OH USA.
Elaine M
EM
Urbina
Cincinnati Children's Hospital, Cincinnati, OH USA.
Lawrence M
LM
Dolan
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO USA.
Stephen R
SR
Daniels
Northwest Lipid Metabolism and Diabetes Research, University of Washington, Seattle, WA USA.
Santica M
SM
Marcovina
Colorado School of Public Health, Aurora, CO USA.
Dana
D
Dabelea
D000293:Adolescent; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008137:Longitudinal Studies; D008297:Male; D063177:Pulse Wave Analysis; D012307:Risk Factors; D059289:Vascular Stiffness
Cardiovascular disease; Insulin resistance; Pediatrics; Pulse wave velocity; Type 1 diabetes