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J Pediatr. 2018 Jan;192:86-92.e5. doi: 10.1016/j.jpeds.2017.09.012.

Cardiac Biomarkers in Youth with Type 2 Diabetes Mellitus: Results from the TODAY Study.

Collaborators (199)

McKay S11, Haymond M11, Anderson B11, Bush C11, Gunn S11, Holden H11, Jones SM11, Jeha G11, McGirk S11, Thamotharan S11, Cuttler L12, Abrams E12, Casey T12, Dahms W12, Ievers-Landis C12, Kaminski B12, Koontz M12, MacLeish S12, McGuigan P12, Narasimhan S12, Geffner M13, Barraza V13, Chang N13, Conrad B13, Dreimane D13, Estrada S13, Fisher L13, Fleury-Milfort E13, Hernandez S13, Hollen B13, Kaufman F13, Law E13, Mansilla V13, Miller D13, Muñoz C13, Ortiz R13, Ward A13, Wexler K13, Xu YK13, Yasuda P13, Levitt Katz L14, Berkowitz R14, Boyd S14, Johnson B14, Kaplan J14, Keating C14, Lassiter C14, Lipman T14, McGinley G14, McKnight H14, Schwartzman B14, Willi S14, Arslanian S15, Bacha F15, Foster S15, Galvin B15, Hannon T15, Kriska A15, Libman I15, Marcus M15, Porter K15, Songer T15, Venditti E15, Goland R16, Gallagher D16, Kringas P16, Leibel N16, Ng D16, Ovalles M16, Seidman D16, Laffel L17, Goebel-Fabbri A17, Hall M17, Higgins L17, Keady J17, Malloy M17, Milaszewski K17, Rasbach L17, Nathan DM18, Angelescu A18, Bissett L18, Ciccarelli C18, Delahanty L18, Goldman V18, Hardy O18, Larkin M18, Levitsky L18, McEachern R18, Norman D18, Nwosu D18, Park-Bennett S18, Richards D18, Sherry N18, Steiner B18, Tollefsen S19, Carnes S19, Dempsher D19, Flomo D19, Whelan T19, Wolff B19, Weinstock R20, Bowerman D20, Bristol S20, Bulger J20, Hartsig J20, Izquierdo R20, Kearns J20, Saletsky R20, Trief P20, Zeitler P21, Abramson N21, Bradhurst A21, Celona-Jacobs N21, Higgins J21, Kelsey M21, Klingensmith G21, Nadeau K21, Witten T21, Copeland K22, Boss E22, Brown R22, Chadwick J22, Chalmers L22, Chernausek S22, Hebensperger A22, Macha C22, Newgent R22, Nordyke A22, Olson D22, Poulsen T22, Pratt L22, Preske J22, Schanuel J22, Sternlof S22, Lynch J23, Amodei N23, Barajas R23, Cody C23, Hale D23, Hernandez J23, Ibarra C23, Morales E23, Rivera S23, Rupert G23, Wauters A23, White N24, Arbeláez A24, Flomo D24, Jones J24, Jones T24, Sadler M24, Tanner M24, Timpson A24, Welch R24, Caprio S25, Grey M25, Guandalini C25, Lavietes S25, Rose P25, Syme A25, Tamborlane W25, Hirst K26, Edelstein S26, Feit P26, Grover N26, Long C26, Pyle L26, Linder B27, Marcovina SM28, Harting J28, Shepherd J29, Fan B29, Marquez L29, Sherman M29, Wang J29, Nichols M30, Mayer-Davis E30, Liu Y30, Lima J31, Gidding S31, Puccella J31, Ricketts E31, Danis R32, Domalpally A32, Goulding A32, Neill S32, Vargo P32, Wilfley D33, Aldrich-Rasche D33, Franklin K33, Massmann C33, O'Brien D33, Patterson J33, Tibbs T33, Van Buren D33, Palmert M34, Ratner R35, Dremaine D36, Silverstein J37.

Author information

1
Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, DE.
2
Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
3
University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
4
Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
5
Massachusetts General Hospital, Boston, MA.
6
University of Texas Health Science Center San Antonio, San Antonio, TX.
7
University of Oklahoma Health Sciences Center, Oklahoma, OK.
8
Department of Medicine, SUNY Upstate Medical University, Syracuse, NY.
9
George Washington University Biostatistics Center, Rockville, MD. Electronic address: elghorml@bsc.gwu.edu.
10
Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD.
11
Baylor College of Medicine.
12
Case Western Reserve University.
13
Children's Hospital Los Angeles.
14
Children's Hospital of Philadelphia.
15
Children's Hospital of Pittsburgh.
16
Columbia University Medical Center.
17
Joslin Diabetes Center.
18
Massachusetts General Hospital.
19
Saint Louis University.
20
State University of New York Upstate Medical University.
21
University of Colorado Denver.
22
University of Oklahoma Health Sciences Center.
23
University of Texas Health Science Center at San Antonio.
24
Washington University in St Louis.
25
Yale University.
26
George Washington University Biostatistics Center.
27
National Institute of Diabetes and Digestive and Kidney Diseases.
28
University of Washington).
29
University of California at San Francisco.
30
University of South Carolina.
31
Johns Hopkins University.
32
University of Wisconsin.
33
Washington University.
34
Other Hospital for Sick Children, Toronto.
35
Medstar Research Institute, Washington DC.
36
Texas Tech University Health Sciences Center.
37
University of Florida.

Abstract

OBJECTIVES:

To examine cardiac biomarkers over time in youth-onset type 2 diabetes, and relate serum concentrations to cardiovascular disease risk factors, and left ventricular structure and function.

STUDY DESIGN:

TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) was a multicenter randomized trial of 3 treatments including 521 participants with type 2 diabetes, aged 10-17 years, and with 2-6 years of follow-up. Participants were 36% male, obese, and ethnically diverse. Annual serum concentrations of brain natriuretic peptide, troponin, tumor necrosis factor (TNF)-α, receptors 1 and 2 were related to blood pressure, body mass index, hemoglobin A1c, and left ventricular ejection fraction, diastolic function, relative wall thickness, and mass.

RESULTS:

Elevated concentrations of brain natriuretic peptide (≥100 pg/mL), TNF-α (≥5.6 pg/mL) and troponin (≥0.01 ng/mL), were present in 17.8%, 18.3%, and 34.2% of the cohort, respectively, at baseline, and in 15.4%, 17.1%, and 31.1% at the end of the study, with wide variability over time, without persistence in individuals or clear relationship to glycemia or cardiovascular structure/function. TNF receptors concentrations were increased at baseline and not significantly different from end-of-study concentrations. Adverse echocardiographic measures were more likely in the highest TNF receptor tertile (all P < .05): higher left ventricular mass (39.3 ± 9.0 g/m2.7), left atrial internal dimension (3.7 ± 0.4 cm) and E/Em ratio, a measure of diastolic dysfunction (6.2 ± 1.9). After adjustment for body mass index, these relationships were no longer significant.

CONCLUSIONS:

Elevated serum concentrations of cardiac biomarkers were common in youth with type 2 diabetes, but their clinical significance is unclear and will require further long-term study.

TRIAL REGISTRATION:

ClinicalTrials.govNCT00081328.

KEYWORDS:

adolescent; cardiac biomarkers; cardiovascular function; cardiovascular risk factors; type 2 diabetes

PMID:
29246363
PMCID:
PMC5806514
DOI:
10.1016/j.jpeds.2017.09.012
[Indexed for MEDLINE]
Free PMC Article

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