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Presenter Disclosures
Petter Bjornstad, M.D.
No conflicts to disclose
We hypothesized:
ISPAD goal achievement at baseline would be
associated with lower odds of cardiorenal risk
factors at baseline and 2-year follow-up
Determinants of Macrovascular
Disease in Type 1 Diabetes
CVD risk factors were measured in a cohort of
300 adolescents with T1D:
Age 12-19 years
T1D for > 5 years duration
Recruited from BDC clinical population
Methods
Relationships between ISPAD goal
achievement at baseline and cardiorenal
health at baseline and 2-year follow-up
(n=297; 15.42.2 years; duration 8.83.0 years;
50% males; 80% NHW; HbA1c 8.91.6%)
Goal achievement was defined as:
- HbA1c<7.5% (58.5mmol/mol)
Cardiovascular outcomes
Cardiovascular (measures of arterial stiffness)
PWV
AIx
BrachD
Measured by Sphygmocor
Measured by DynaPulse
Renal outcomes
Renal
Continuous
eGFR by Schwartz (36.5 * height/creatinine)
eGFR by Bouvet (63.2 *[1.2/cystatin C]0.56 * [(96/88.4)/creatinine]0.35 *
[weight/45]0.30 * [age/14]0.40 )
ACR
Dichotomous
Elevated ACR (30mg/g)
Hyperfiltration (135mL/min/1.73m2)
Results
We stratified the BDC cohort into participants
who:
Met 1-3 goals (n=222)
Met 4-6 goals (n=75)
Univariate models
Variables
P-value
Cardiovascular variables
PWV at baseline (m/s)
5.70.7
5.20.6 <0.0001
PWV at follow-up (m/s)
6.10.8
5.70.7 0.0001
BrachD at baseline (%/mm Hg)
6.41.1
6.91.3 0.004
BrachD at follow-up (%/mm Hg)
0.81
6.61.2
6.71.2
AIx* HR75 at baseline (%)
2.0 (-2.7-9.0) 2.7 (-3.0-9.0)
0.85
AIx* HR75 at follow-up (%)
6.5 (-0.8-10.5) 4.7 (-2.2-10.0)
0.17
Renal variables
Baseline eGFR by Bouvet
13422
11617 <0.0001
Follow-up eGFR by Schwartz
10923
9915 0.0003
Baseline eGFR by Schwartz
0.97
10921
10820
Baseline ACR* (mg/g)
7 (5-15)
7 (4-13)
0.98
Follow-up ACR* (mg/g)
7 (4-16)
6 (4-13)
0.12
Variables
Cardiovascular variables
Baseline PWV (m/s)
5.40.1
Follow-up PWV (m/s)
5.70.1
Baseline BrachD (%/mm Hg)
6.90.2
Follow-up AIx HR75 (%)
8.41.6
Renal variables
Baseline eGFR Bouvet
1273
(mL/min/1.73m2)
Follow-up eGFR Schwartz
(mL/min/1.73m2)
1163
(n=222)
5.10.1 0.0001
5.50.1
0.03
7.30.1
0.02
5.41.0 0.0498
1142 <0.0001
1042 <0.0001
N=56
N=36
Odds of hyperfiltration
at follow-up in
O d d s o f h y p e r f ilt r a t io n a t f o llo w - u p in s u b je c t s w
t 1 - 3 g o a ls v s 4 - 6 g o a l s
subjects who metm e1-3
vs. 4-6 goals
O R : 2 0 .0 ( 9 5 % C I 3 .8 - 1 0 5 .2 , p = 0 .0 0 0 4 )
F o llo w - u p h yp e r f ilt r a t io n ( S c h w a r t z )
0
1
0
1
0
9
0
8
0
7
0
6
0
5
0
4
0
3
0
2
0
1
N=11
O d d s r a t io s
( A d ju s te d fo r a g e , s e x a n d T 1 D d u r a tio n )
Limitations
Observational design
Mostly post-pubertal cohort not applicable
to pre-pubertal adolescents
Estimated rather than measured GFR
Cystatin C only available at baseline visit
Surrogate outcomes (risk factors of cardiorenal health)
Conclusions
7% of participants met all ISPAD goals
25% met 3 ISPAD goals
>3 goals at baseline associated with
cardiorenal protection at baseline and 2-year
follow-up
Achieving ISPAD goals in adolescence may
translate to better long-term health.
Acknowledgements
Special thanks to the patients and their family
for their participation.
Study supported by JDRF (11-2007-694),
NIDDK (DK075360) and NIH/NCATS Colorado
CTSI Grant Number (UL1 TR000154)
Thank you
94% 94%
T1DX
78%
91% 89%
73%
69% 69%
62%
21%
15%
HbA1c <7.5%
BP <90th
LDL-C
<100mg/dL
HDL-C >
35mg/dL
TG<150mg/dL
BMI <85th
percentile