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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #351132
Title: Cardiac biomarkers in youth with type 2 diabetes mellitus: Results from the Today Study

Author
item GIDDING, SAMUEL - Dupont - Delaware
item BACHA, FIDA - Children'S Nutrition Research Center (CNRC)
item BJORNSTAD, PETTER - University Of Colorado
item LEVITT KATZ, LORRAINE - Children'S Hospital - Philadelphia, Pennsylvania
item LEVITSKY, LYNNE - Massachusetts General Hospital
item LYNCH, JANE - University Of Texas At San Antonio
item TRYGGESTAD, JEANIE - University Of Oklahoma Health Sciences Center
item WEINSTOCK, RUTH - State University Of New York (SUNY)
item EL GHORMLI, LAURE - George Washington University
item LIMA, JOAO A - Johns Hopkins University

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/7/2017
Publication Date: 1/1/2018
Citation: Gidding, S.S., Bacha, F., Bjornstad, P., Levitt Katz, L.E., Levitsky, L.L., Lynch, J., Tryggestad, J.B., Weinstock, R.S., El Ghormli, L., Lima, J.C. 2018. Cardiac biomarkers in youth with type 2 diabetes mellitus: Results from the Today Study. Journal of Pediatrics. 192:86-92. https://doi.org10.1016/j.jpeds.2017.09.012.

Interpretive Summary: Substances measured in the blood and related to the heart function (called cardiac biomarkers) are related to heart disease in adults with type 2 diabetes (T2D). They have been little studied in adolescents. We examined cardiac biomarkers over time in youth-onset T2D to understand their relationship to risk factors for heart disease. 521 adolescents with youth onset T2D, aged 10-17 years, were followed for 2-6 years in the Treatment Options for T2D in adolescents and youth (TODAY) study. Annual serum concentrations of cardiac biomarkers were obtained. We found that the levels of these substances in the blood were related to blood pressure, body mass index (BMI), glucose levels and heart mass and function. However, the concentrations of these substances varied over time. We conclude that elevated serum concentrations of cardiac biomarkers are common in youth with T2D, but their clinical significance is unclear and will require further long-term study.

Technical Abstract: To examine cardiac biomarkers over time in youth-onset type 2 diabetes, and relate serum concentrations to cardiovascular disease risk factors, and left ventricular structure and function. TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) was a multicenter randomized trial of 3 treatments including 521 participants with type 2 diabetes, aged 10-17 years, and with 2-6 years of follow-up. Participants were 36% male, obese, and ethnically diverse. Annual serum concentrations of brain natriuretic peptide, troponin, tumor necrosis factor (TNF) alpha, receptors 1 and 2 were related to blood pressure, body mass index, hemoglobin A1C, and left ventricular ejection fraction, diastolic function, relative wall thickness, and mass. Elevated concentrations of brain natriuretic peptide (>/=100 pg/mL), TNF-a (>/=5.6 pg/mL) and troponin (>/=0.01 ng/mL), were present in 17.8%, 18.3%, and 34.2% of the cohort, respectively, at baseline, and in 15.4%, 17.1%, and 31.1% at the end of the study, with wide variability over time, without persistence in individuals or clear relationship to glycemic or cardiovascular structure/function. TNF receptors concentrations were increased at baseline and not significantly different from end-of-study concentrations. Adverse echocardiographic measures were more likely in the highest TNF receptor tertile (all P < .05): higher left ventricular mass (39.3 +/- 9.0 g/m2.7), left atrial internal dimension (3.7 +/- 0.4 cm) and E/Em ratio, a measure of diastolic dysfunction (6.2 +/- 1.9). After adjustment for body mass index, these relationships were no longer significant. Elevated serum concentrations of cardiac biomarkers were common in youth with type 2 diabetes, but their clinical significance is unclear and will require further long-term study.