Longitudinal changes in vascular stiffness and heart rate variability among young adults with youth-onset type 2 diabetes: Results from the follow-up observational treatment options for type 2 diabetes in adolescents and yout

Authors: SHAH, AMY - University Of Cincinnati; EL GHORMI, LAURE - George Washington University; GIDDING, SAMUEL - Nemours/alfred I Dupont Hospital For Children; HUGHAN, KARA - University Of Pittsburgh Medical Center; LEVITT KATZ, LORRAINE - Children'S Hospital - Philadelphia, Pennsylvania; KOREN, DORIT - Massachusetts General Hospital; TRYGGESTAD, JEANIE - University Of Oklahoma Health Sciences Center; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); BRAFFETT, BARBARA - George Washington University; ARSLANIAN, SILVA - University Of Pittsburgh Medical Center; URBINA, ELAINE - University Of Cincinnati

Submitted to: Acta Diabetologica
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/30/2021
Publication Date: 9/20/2021
Citation: The TODAY Study Group, Shah, A.S., El Ghormi, L., Gidding, S.S., Hughan, K.S., Levitt Katz, L.E., Koren, D., Tryggestad, J.B., Bacha, F., Braffett, B.H., Arslanian, S., Urbina, E.M. 2021. Longitudinal changes in vascular stiffness and heart rate variability among young adults with youth-onset type 2 diabetes: Results from the follow-up observational treatment options for type 2 diabetes in adolescents and youth (TODAY) study. Acta Diabetologia. 59(2):197-205. https://doi.org/10.1007/s00592-021-01796-6.
DOI: https://doi.org/10.1007/s00592-021-01796-6

Interpretive Summary: Youth with type 2 diabetes have evidence of vessel stiffness. It is unclear how this progresses over time in youth and are the risk factors for worsening of vessel stiffness. In this study, the investigators examined changes in arterial stiffness and heart rate variability (HRV) over a 5-year interval in youth with youth-onset type 2 diabetes enrolled from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Participants underwent assessment of arterial stiffness [pulse wave velocity, augmentation index, brachial distensibility] and six indices of HRV, 5 years apart. They found that in more than half the cohort pulse wave velocity, augmentation index and HRV worsened over 5 years. Blood pressure related to worsening in vascular stiffness. Elevated blood glucose related to worsening vascular stiffness and HRV. They concluded that blood pressure and glucose control are potential targets to prevent adverse changes in arterial stiffness and HRV in young adults with youth-onset type 2 diabetes.

Technical Abstract: To describe changes in arterial stiffness and heart rate variability (HRV) over a 5-year interval, (2) examine changes by sex and race-ethnicity, and (3) evaluate the risk factors associated with the longitudinal changes in arterial stiffness and HRV. Participants with youth-onset type 2 diabetes enrolled in the observational follow-up phase of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial had arterial stiffness [(pulse wave velocity, augmentation index, brachial distensibility] and six indices of HRV measured 5 years apart. Multivariable linear regression models assessed risk factors associated with changes in the outcomes over time. At initial vascular assessment, the 304 participants were a mean age of 21 years, 34% male, and had a mean diabetes duration of 8 years. In more than half the cohort pulse wave velocity, augmentation index and HRV increased over 5 years (p<0.01). Brachial distensibility did not change. There were no differences in the 5-year change by race/ethnicity except for a single HRV measure, where non-Hispanic Blacks had greater worsening of parasympathetic function compared to non-Hispanic Whites, p = 0.008. Blood pressure was related to greater worsening in augmentation index and pulse wave velocity. Higher hemoglobin A1C over time was related to worsening pulse wave velocity and HRV. Arterial stiffness and HRV worsened over 5 years. Blood pressure and glycemic control may be potential targets to influence adverse changes in arterial stiffness and HRV in young adults with youth-onset type 2 diabetes.