O-44: Beyond HbA1c: insulin sensitivity, central adiposity, and early cardiovascular remodeling in adolescents with type 1 diabetes
F Iafrate Luterbacher, M Dolmatov, M G Friedrich, A Benedetti, S Harnois-Leblanc, J -L Bigras, A Van Hulst, A M Nuyt, T A Barnett, M HendersonAbstract
Introduction
Early cardiovascular remodeling is increasingly recognized in youth with type 1 diabetes (T1D), but the relative contribution of cardiometabolic factors remains unclear.
Objectives
To estimate associations of insulin sensitivity (IS), adiposity and HbA1c with cardiac and vascular structure in adolescents.
Methods
Cross-sectional study of 197 adolescents (100 T1D, 97 controls; mean age 16.3±1.3 years). Outcomes included cardiac MRI measures of left ventricular (LV) structure/function and vascular function (pulse wave velocity (PWV), flow acceleration, velocity time integral). Multivariable linear regression models estimated associations of IS (Dabelea, 2011), waist circumference (WC), % fat mass, and HbA1c with outcomes, adjusted for sex, Tanner stage, diabetes status, moderate-to-vigorous physical activity, income, ethnicity, heart rate (vascular outcomes), and height (LV volumes).
Results
Higher IS was associated with lower LV mass/height (β = -3.32 [-4.86; -1.78] g/m) and wall thickness (β = -0.39 [-0.62; -0.15] mm) in controls, with attenuation in T1D, (β [95% CI] change in outcome per unit increase in exposure). While total adiposity was negatively associated with papillary mass only, WC was associated with greater LV mass/height (β = 0.57 [0.10; 1.03]), wall thickness (β = 0.07 [0.00; 0.15]), and LV end-diastolic volume (β = 0.21 [−0.53; 0.96]) in both groups. HbA1c was inversely associated with LV mass/height in T1D only (β = -2.73 [-5.35; -0.12]) and positively associated with PWV in controls (β = 0.60 [0.05; 1.14]), attenuated in T1D.
Conclusions
Early cardiovascular remodeling in adolescents with T1D cannot be explained by glycemic control alone and appears partly related to IS and central adiposity, which showed more consistent associations than total adiposity. The attenuation of several associations in T1D suggests distinct cardiometabolic pathways of early cardiovascular risk in pediatric T1D and supports a broader framework for early cardiovascular risk assessment.