CV Disease in Adolescents with Type 2 Diabetes

描述(由申请人提供)：青少年中2型糖尿病的患病率急剧增加。这似乎是儿科人群肥胖患病率和严重程度增加的直接结果。众所周知，在患有2型糖尿病的成年人中，患心血管疾病(CVD)的风险相当高。这导致了目前的临床建议，认为患有糖尿病的成年人与那些已经患有冠状动脉疾病的成年人的风险相同。目前尚不清楚患有2型糖尿病的青少年是否与成年人一样有高水平的心血管疾病风险。如果他们这样做，那么预计他们将在20岁左右的S或30岁的S出现临床心血管疾病。这将具有重要的临床意义，并表明需要非常积极地管理心血管疾病危险因素和糖尿病。这项拟议的研究是对患有2型糖尿病的青少年群体的心脏和血管结构和功能的横断面评估，并与年龄、性别、种族和体重指数相似的单纯肥胖组和年龄、性别和种族相似的非肥胖组进行比较。将对300名2型糖尿病患者、300名肥胖者和300名非肥胖者进行研究。对心血管疾病发展的评估将使用亚临床动脉粥样硬化的新的非侵入性成像方法，包括心脏结构和功能的超声心动图测量，颈动脉内中膜厚度的超声评估，以及通过臂动脉反应性评估内皮功能。基本假设是，与肥胖对照组相比，患有2型糖尿病的青少年在心脏和血管结构和功能方面的异常更严重。与非肥胖者相比，单纯肥胖的受试者在心脏和血管结构和功能上会有更大的异常。还将评估心脏和血管异常的相关性，包括炎症标记物、脂联素、饮食和体力活动。拟议研究的结果将填补一项重要的知识空白，将作为未来纵向研究的基线，并可能为预防年轻2型糖尿病患者和肥胖者心血管疾病发展的临床策略提供基础。

DESCRIPTION (provided by applicant): The prevalence of type 2 diabetes mellitus has increased dramatically in adolescents. This appears to be a direct result of the increase in prevalence and severity of obesity in the pediatric population. In adults with type 2 diabetes, it is well known that the risk for cardiovascular disease (CVD) is quite high. This has led to current clinical recommendation that adults with diabetes be considered equivalent in risk to those adults who already have existing coronary artery disease. It is not known if adolescents with type 2 diabetes have an equivalent high level of risk of CVD as the adult population. If they do then it would be expected that they would develop clinical CVD in their late 20's or 30's. This would have important clinical implications and would suggest the need for very aggressive management of CVD risk factors and diabetes. The proposed study is a cross-sectional evaluation of cardiac and vascular structure and function in a population of adolescents with type 2 diabetes compared to a group with similar age, sex, race and BMI with obesity alone and a non obese group with similar age, sex and race. 300 subjects with type 2 diabetes, 300 subjects with obesity and 300 non obese subjects will be studied. Assessment of CVD development will be accomplished using novel non invasive imaging methods for subclinical atherosclerosis including echocardiographic measurement of cardiac structure and function, ultrasound evaluation of carotid intimalmedial thickness, and evaluation of endothelial function by brachial artery reactivity. The primary hypothesis is that adolescents with type 2 diabetes will have greater abnormality in cardiac and vascular structure and function compared to controls with obesity. Subjects with obesity alone will have greater abnormality in cardiac and vascular structure and function compared to controls who are not obese. Correlates of cardiac and vascular abnormalities including markers of inflammation, adiponectin, diet and physical activity will also be evaluated. The results of the proposed study will fill an important gap in knowledge, will serve as the baseline for future longitudinal studies and may provide the basis for clinical strategies to prevent the development of CVD in young patients with type 2 diabetes and those with obesity.