Determinants of Cardiovascular Risk in 7000 Youth with Type 1 Diabetes in the Australasian Diabetes Data Network

Jenny J. Couper, Timothy W. Jones, Melissa Chee, Helen L. Barrett, Philip Bergman, Fergus Cameron, Maria E. Craig, Peter Colman, Elizabeth E. Davis, Kim C. Donaghue, P. Gerry Fegan, P. Shane Hamblin, D. Jane Holmes-Walker, Craig Jefferies, Stephanie Johnson, Meng Tuck Mok, Bruce R. King, Richard Sinnott, Glenn Ward, Benjamin J. WheelerAnthony Zimmermann, Arul Earnest, the ADDN Study Group

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Context: Cardiovascular disease occurs prematurely in type 1 diabetes. The additional risk of overweight is not well characterized. Objective: The primary aim was to measure the impact of body mass index (BMI) in youth with type 1 diabetes on cardiovascular risk factors. The secondary aim was to identify other determinants of cardiovascular risk. Design: Observational longitudinal study of 7061 youth with type 1 diabetes followed for median 7.3 (interquartile range [IQR] 4-11) years over 41 (IQR 29-56) visits until March 2019. Setting: 15 tertiary care diabetes centers in the Australasian Diabetes Data Network. Participants were aged 2 to 25 years at baseline, with at least 2 measurements of BMI and blood pressure. Main Outcome Measure: Standardized systolic and diastolic blood pressure scores and non-high-density lipoprotein (HDL) cholesterol were co-primary outcomes. Urinary albumin/creatinine ratio was the secondary outcome. Results: BMI z-score related independently to standardized blood pressure z- scores and non-HDL cholesterol. An increase in 1 BMI z-score related to an average increase in systolic/diastolic blood pressure of 3.8/1.4 mmHg and an increase in non-HDL cholesterol (coefficient + 0.16 mmol/L, 95% confidence interval [CI], 0.13-0.18; P < 0.001) and in low-density lipoprotein (LDL) cholesterol. Females had higher blood pressure z-scores, higher non-HDL and LDL cholesterol, and higher urinary albumin/creatinine than males. Indigenous youth had markedly higher urinary albumin/creatinine (coefficient + 2.15 mg/mmol, 95% CI, 1.27-3.03; P < 0.001) and higher non-HDL cholesterol than non-Indigenous youth. Continuous subcutaneous insulin infusion was associated independently with lower non-HDL cholesterol and lower urinary albumin/creatinine. Conclusions: BMI had a modest independent effect on cardiovascular risk. Females and Indigenous Australians in particular had a more adverse risk profile.

Original languageEnglish
Pages (from-to)133-142
Number of pages10
JournalThe Journal of Clinical Endocrinology and Metabolism
Issue number1
Publication statusPublished - Jan 2021


  • adolescents
  • cardiovascular risk
  • Children
  • type 1 diabetes

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