CV Disease in Adolescents With Type 2 Diabetes

BACKGROUND:

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.

DESIGN NARRATIVE:

The 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 intimal medial 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.