title: Youth with type 1 diabetes have worse strain and less pronounced sex differences in early echocardiographic markers of diabetic cardiomyopathy compared to their normoglycemic peers: A RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) Study.
abstract: Diabetic cardiomyopathy is a major cause of morbidity, but limited data are available on early cardiac abnormalities in type 1 diabetes (T1D). We investigated differences in myocardial strain in adolescents with and without T1D. We hypothesized that adolescents with T1D would have worse strain than their normoglycemic peers, which boys would have worse strain than girls, and that strain would correlate with glycemic control and adipokines.
  
  
  
  We performed fasting laboratory measures and echocardiograms with speckle tracking to evaluate traditional echocardiographic measures in addition to longitudinal (LS) and circumferential (CS) strain, and in adolescents (15±2years) with (19 boys; 22 girls) and without (16 boys; 32 girls) type 1 diabetes.
  
  
  
  Compared to controls, adolescents with type 1 diabetes had significantly lower CS (-20.9 vs. -22.7%, p=0.02), but not LS (p=0.83). Boys with T1D had significantly lower LS than girls with T1D (-17.5 vs. -19.7%, p=0.047), adjusted for Tanner stage. The significant sex differences observed in indexed left ventricular mass, left end-diastolic volume, diastolic septal and posterior wall thickness in our controls were lacking in adolescents with T1D.
  
  
  
  Our observations suggest that youth with T1D have worse myocardial strain than normoglycemic peers. In addition, the relatively favorable cardiac profile observed in girls vs. boys in the control group, was attenuated in T1D. These early cardiovascular changes in youth with T1D are concerning and warrant longitudinal and mechanistic studies.
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States. Electronic address: 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, United States.
authors.forename: Uyen
authors.initials: U
authors.lastname: Truong
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dorosz
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Melanie
authors.initials: M
authors.lastname: Cree-Green
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Baumgartner
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Gregory
authors.initials: G
authors.lastname: Coe
authors.affiliation: Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Judith G
authors.initials: JG
authors.lastname: Regensteiner
authors.affiliation: Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Division of Endocrinology, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO, United States.
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, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Nadeau
mesh_terms: D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D058065:Diabetic Cardiomyopathies / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D012727:Sex Characteristics
keywords: Adolescents; Diabetic cardiomyopathy; Left ventricular strain; Macrovascular complications; Myocardial mechanics; Type 1 diabetes