medwireNews: Research from the TODAY2 study reported at the virtual ADA 81st Scientific Sessions suggests that young people with type 2 diabetes, particularly those with poor glycemic control and high blood pressure, experience worsening arterial stiffness and heart rate variability (HRV) over time.
Amy Shah (Cincinnati Children's Hospital, Ohio, USA) and colleagues evaluated data from 304 people (34% men) who participated in the TODAY trial and had arterial stiffness and HRV measurements in the longitudinal observational TODAY2 study that followed. At the beginning of TODAY2, participants were aged an average of 20.8 years, with a mean diabetes duration of 7.7 years and a mean glycated hemoglobin (HbA1c) level of 8.8% (73 mmol/mol).
Shah reported that two measures of arterial stiffness increased significantly from TODAY2 baseline to the 5-year follow-up. Average carotid–femoral pulse wave velocity (cf-PWV) increased from 6.3 to 7.1 m/s, while the mean augmentation index increased from 9.4% to 14.9%. A total of 68.7% and 73.6% of individuals, respectively, experienced worsening in these measures.
Average HRV also worsened significantly during the study period, from 50.8 ms at baseline to 40.1 ms at 5 years, with 66.8% of participants experiencing a decrease in HRV.
“The observed annual change in cf-PWV seen in the TODAY2 cohort is comparable to [that seen in] adults aged approximately 50 years who have had diabetes for about 15–20 years,” said Shah.
She added: “The low HRV seen at both the initial and follow-up evaluations suggests that youth with recent-onset type 2 diabetes may be at high risk for future cardiovascular complications.”
Using a multivariable model adjusting for factors including age, BMI, smoking, and low-density lipoprotein cholesterol, the researchers found that higher cumulative glycemic exposure, as measured by time-weighted HbA1c levels, was significantly associated with worsening cf-PWV and HRV, while female sex and higher average arterial blood pressure were significantly associated with worsening augmentation index.
Conversely, there were no associations between race/ethnicity and worsening of arterial stiffness or HRV, said Shah.
“Lowering HbA1c and blood pressure may be important to improve long-term cardiovascular outcomes in this cohort,” she concluded.
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