title: Cardiopulmonary Dysfunction and Adiponectin in Adolescents With Type 2 Diabetes.
abstract: BACKGROUND
  Myocardial mechanics are altered in adults with obesity and type 2 diabetes (T2D); insulin resistance and adipokines have been implicated as important risk factors for cardiovascular disease, but these relationships are poorly described in adolescents. We hypothesized that obese adolescents and adolescents with T2D would have abnormal cardiac function compared to lean adolescents. In addition, we hypothesized that insulin sensitivity (IS), adiposity, and adipokines would be associated with altered cardiac strain and cardiopulmonary fitness in adolescents with T2D.
  
  
  RESULTS
  Adolescents (15±2 years) with T2D (n=37), obesity without diabetes (n=41), and lean controls (n=31) of similar age and pubertal stage underwent echocardiography with speckle tracking, assessment of IS by hyperinsulinemic-euglycemic clamp, body composition by dual-energy x-ray absorptiometry, peak oxygen consumption (VO2peak) by cycle ergometry, adiponectin, and leptin. Compared to lean and to obese controls, adolescents with T2D had significantly lower cardiac circumferential strain (CS) (-18.9±4.6 [T2D] versus -21.5±3.5 [obese] versus -22.0±4.2% [lean], P=0.04) and VO2peak (37.6±7.5 [T2D] versus 43.4±8.2 [obese] versus 47.6±8.6 mL/lean kg/min [lean], P<0.0001). In T2D youth, VO2peak was associated with CS, and the association remained significant after adjusting for age, sex, and IS (β±SE: -0.73±0.26, P=0.02). Among adolescents with T2D, CS was also associated with adiponectin, longitudinal strain with leptin, and VO2peak with adiponectin and IS.
  
  
  CONCLUSIONS
  Adolescents with T2D had abnormal CS and reduced VO2peak compared to obese and lean controls, which may represent the earliest evidence of cardiac functional impairment in T2D. Low adiponectin, rather than conventional risk factors and IS, correlated with CS, while both adiponectin and IS related to cardiopulmonary fitness.
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO petter.bjornstad@childrenscolorado.org.
authors.forename: Petter
authors.initials: P
authors.lastname: Bjornstad
authors.affiliation: Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Uyen
authors.initials: U
authors.lastname: Truong
authors.affiliation: Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dorosz
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Melanie
authors.initials: M
authors.lastname: Cree-Green
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Amy
authors.initials: A
authors.lastname: Baumgartner
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Gregory
authors.initials: G
authors.lastname: Coe
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Divisions of General Internal Medicine and Cardiology, Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Judith G
authors.initials: JG
authors.lastname: Regensteiner
authors.affiliation: Division of Endocrinology, Center for Women's Health Research, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Jane E B
authors.initials: JE
authors.lastname: Reusch
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Nadeau
mesh_terms: D015502:Absorptiometry, Photon; D052242:Adiponectin / Q000097:blood*; D050154:Adiposity; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D010101:Oxygen Consumption; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013314:Stress, Mechanical; D016277:Ventricular Function, Left
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers
keywords: diabetic cardiomyopathy; left ventricular strain; myocardial mechanics; type 2 diabetes