Are Overweight Children with T1DM at Increased Risk of Cardiovascular Disease?

描述(由申请人提供)：英格丽德·利布曼博士是一名儿科内分泌学家，曾接受过流行病学培训，目前是匹兹堡大学儿科学助理教授。该候选人的长期目标是成为一名学术内科医生和独立临床科学家，将她的培训从基于人群的儿童糖尿病(DM)流行病学领域扩展到以患者为导向的干预研究，特别关注肥胖对1型糖尿病(T1 DM)的影响，特别是对心血管疾病(CVD)的发展。这种兴趣是在利布曼博士发现肥胖在这一人群中的患病率上升的最后几年里产生的，这些人通常被认为不超重。这一增长的后果目前尚不清楚。在席尔瓦·阿尔斯兰尼博士、Dorothy Becker博士、Ronald LaPorte博士和Bradley Keller博士的指导下，Libman博士提出了一项全面的职业发展计划，包括使用高胰岛素-正常血糖钳评估胰岛素抵抗的培训，测量早期心血管疾病标志物(如颈动脉超声)以测量内膜中层厚度和脉搏波速度，以及在面向患者的临床研究中精心选择的课程工作。本研究采用为期三年的横断面研究方法，对超重伴T1 DM组、非超重伴T1 DM组和超重非DM组进行CVD早期危险因素的比较研究。这项研究还将评估胰岛素抵抗的作用，通过使用高胰岛素-正常血糖钳夹技术在前两组中测量，并验证胰岛素抵抗综合征评分，该评分由可能用于临床和基于人群的研究的临床参数组成。这项研究招募了120名年龄在12岁至18岁之间的儿童，他们将在儿科临床翻译研究中心(PCTRC)工作24小时，接受问卷调查、人体测量、血压、空腹血液测试、全身地塞米松、颈动脉超声检查，并在糖尿病组进行高胰岛素-正常血糖钳夹检查。这项研究的目的是1)检验这样一种假设，即超重的T1 DM儿童比那些没有超重的T1 DM儿童有更多的早期动脉粥样硬化标记物，这是由构成代谢综合征的因素调节的；2)评估胰岛素抵抗的作用。(摘要结束)

DESCRIPTION (provided by applicant): Dr. Ingrid Libman is a pediatric endocrinologist with previous training in epidemiology who is currently an Assistant Professor in Pediatrics at the University of Pittsburgh. The candidate's long term goal is to become an academic physician and independent clinical scientist expanding her training from the area of population based epidemiology of childhood diabetes mellitus (DM) to patient oriented and interventional research, with particular focus on the impact of obesity on type 1 diabetes mellitus (T1 DM), in particular on the development of cardiovascular disease (CVD). This interest developed during the last years when Dr. Libman identified an increase in the prevalence of obesity in this population, usually considered not to be overweight. The consequences of this increase are currently not known. Under the mentorships of Drs. Silva Arslanian, Dorothy Becker, Ronald LaPorte and Bradley Keller, Dr. Libman proposes a comprehensive career development plan composed of training in the use of the hyperinsulinemic-euglycemic clamp to assess insulin resistance, measurement of early CVD markers such as carotid ultrasonography to measure intima media thickness and pulse wave velocity and carefully selected course work in clinical patient-oriented research. The research plan is a three year cross sectional study of three groups of children: overweight children with T1DM, non-overweight children with T1DM and overweight children with no DM in order to compare early risk markers of CVD. This study will also assess the role of insulin resistance, measured by the use of the hyperinsulinemic-euglycemic clamp technique in the first two groups, and validate an insulin resistance syndrome score, consisting of clinical parameters which could potentially be used in clinical and population-based studies. This study will recruit 120 children between the ages of 12 and 18 years who will attend the Pediatric Clinical Translational Research Center (PCTRC) for 24 hours to undergo questionnaire, body anthropometry, blood pressure, fasting blood tests, whole body DEXA, carotid ultrasonography and in the groups with diabetes, an hyper insulinemic-euglycemic clamp. Objectives of the study are to 1) test the hypothesis that overweight children with T1 DM have more markers of early atherosclerosis compared to those with T1DM who are not overweight and to those equally overweight with no diabetes and this is mediated by factors which constitute the metabolic syndrome and 2) assess the role of insulin resistance. (End of Abstract)