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Publication Detail

Title: Longitudinal Phenotypes of Type 1 Diabetes in Youth Based on Weight and Glycemia and Their Association With Complications.

Authors: Kahkoska, Anna R; Nguyen, Crystal T; Adair, Linda A; Aiello, Allison E; Burger, Kyle S; Buse, John B; Dabelea, Dana; Dolan, Lawrence M; Malik, Faisal S; Mottl, Amy K; Pihoker, Catherine; Reboussin, Beth A; Sauder, Katherine A; Kosorok, Michael R; Mayer-Davis, Elizabeth J

Published In J Clin Endocrinol Metab, (2019 12 01)

Abstract: CONTEXT: Subclinical and clinical complications emerge early in type 1 diabetes (T1D) and may be associated with obesity and hyperglycemia. OBJECTIVE: Test how longitudinal "weight-glycemia" phenotypes increase susceptibility to different patterns of early/subclinical complications among youth with T1D. DESIGN: SEARCH for Diabetes in Youth observational study. SETTING: Population-based cohort. PARTICIPANTS: Youth with T1D (n = 570) diagnosed 2002 to 2006 or 2008. MAIN OUTCOME MEASURES: Participants were clustered based on longitudinal body mass index z score and HbA1c from a baseline visit and 5+ year follow-up visit (mean diabetes duration: 1.4 ± 0.4 years and 8.2 ± 1.9 years, respectively). Logistic regression modeling tested cluster associations with seven early/subclinical diabetes complications at follow-up, adjusting for sex, race/ethnicity, age, and duration. RESULTS: Four longitudinal weight-glycemia clusters were identified: The Referent Cluster (n = 195, 34.3%), the Hyperglycemia Only Cluster (n = 53, 9.3%), the Elevated Weight Only Cluster (n = 206, 36.1%), and the Elevated Weight With Increasing Hyperglycemia (EWH) Cluster (n = 115, 20.2%). Compared with the Referent Cluster, the Hyperglycemia Only Cluster had elevated odds of dyslipidemia [adjusted odds ratio (aOR) 2.22, 95% CI: 1.15 to 4.29], retinopathy (aOR 9.98, 95% CI: 2.49 to 40.0), and diabetic kidney disease (DKD) (aOR 4.16, 95% CI: 1.37 to 12.62). The EWH Cluster had elevated odds of hypertension (aOR 2.18, 95% CI: 1.19 to 4.00), dyslipidemia (aOR 2.36, 95% CI: 1.41 to 3.95), arterial stiffness (aOR 2.46, 95% CI: 1.09 to 5.53), retinopathy (aOR 5.11, 95% CI: 1.34 to 19.46), and DKD (aOR 3.43, 95% CI: 1.29 to 9.11). CONCLUSIONS: Weight-glycemia phenotypes show different patterns of complications, particularly markers of subclinical macrovascular disease, even in the first decade of T1D.

PubMed ID: 31290977 Exiting the NIEHS site

MeSH Terms: Adolescent; Asymptomatic Diseases/epidemiology; Blood Glucose/metabolism*; Body Weight/physiology*; Child; Child, Preschool; Diabetes Complications/blood; Diabetes Complications/epidemiology; Diabetes Complications/etiology*; Diabetes Mellitus, Type 1*/blood; Diabetes Mellitus, Type 1*/complications; Diabetes Mellitus, Type 1*/epidemiology; Female; Humans; Longitudinal Studies; Male; Phenotype; Risk Factors; Young Adult

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