CV Disease in Adolescents with Type 2 Diabetes

描述（由申请人提供）：2型糖尿病的患病率在青少年中急剧增加。这似乎是儿童肥胖患病率和严重程度增加的直接结果。众所周知，成人2型糖尿病患者患心血管疾病（CVD）的风险相当高。这导致了目前的临床建议，认为糖尿病成年人与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型糖尿病的青少年患心血管疾病的风险是否与成年人相当高。如果他们这样做了，那么预计他们会在20多岁或30多岁时患上临床心血管疾病。这将具有重要的临床意义，并提示需要对心血管疾病危险因素和糖尿病进行非常积极的管理。该研究是对2型糖尿病青少年人群的心脏和血管结构和功能进行横断面评估，将其与年龄、性别、种族和体重指数相似的单独肥胖组和年龄、性别和种族相似的非肥胖组进行比较。研究对象包括300名2型糖尿病患者、300名肥胖患者和300名非肥胖患者。CVD发展的评估将通过新型的无创亚临床动脉粥样硬化成像方法来完成，包括超声心动图测量心脏结构和功能，超声评估颈动脉内膜内侧厚度，以及通过肱动脉反应性评估内皮功能。主要的假设是，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有更大的异常。与不肥胖的对照组相比，单独肥胖的受试者在心脏和血管结构和功能方面会有更大的异常。心脏和血管异常的相关因素包括炎症标志物、脂联素、饮食和体育活动也将被评估。本研究的结果将填补这一重要的知识空白，为未来的纵向研究奠定基础，并可能为预防年轻2型糖尿病患者和肥胖患者心血管疾病的发展提供临床策略基础。

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.