Prediabetes: The Effects on Arterial Thickness and Stiffness in Obese Youth

• Published in: The journal of clinical endocrinology and metabolism Vol. 99; no. 3; pp. 1037 - 1043
• Main Authors: Shah, Amy S, Gao, Zhiqian, Urbina, Elaine M, Kimball, Thomas R, Dolan, Lawrence M
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.03.2014; Copyright by The Endocrine Society
• Subjects: Adolescent; Adult; Biological and medical sciences; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Carotid Arteries - physiopathology; Carotid Intima-Media Thickness; Child; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - physiopathology; Endocrine Research; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Pediatric Obesity - diagnostic imaging; Pediatric Obesity - pathology; Pediatric Obesity - physiopathology; Prediabetic State - pathology; Prediabetic State - physiopathology; Pulse Wave Analysis; Vascular Resistance; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult; Human; Obesity; Nutrition; Nutrition disorder; Cardiovascular disease; Metabolic diseases; Vascular disease; Thickness; Adolescent; Atherosclerosis; Stiffness; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2013-3519

Objective: Adults with prediabetes are at increased risk to develop cardiovascular disease. Whether prediabetes in adolescents is associated with early markers of cardiovascular disease is not known. We sought to 1) compare the cardiovascular risk profiles among adolescents and young adults with prediabetes with those with normal glucose tolerance and 2) determine whether prediabetes is independently associated with noninvasive measures of arterial thickness and stiffness. Research Design and Methods: We studied 102 obese youth with prediabetes and 139 obese youth with normal glucose tolerance in a cross-sectional study. Prediabetes or at increased diabetes risk was diagnosed by a fasting blood glucose level of ≥100 to 125 mg/dL, 2-hour oral glucose tolerance test value of ≥140 to 199 mg/dL, or a hemoglobin A1c (HbA1c) value of ≥5.7% to 6.4%. Arterial thickness and stiffness were measured by carotid intima-media thickness (IMT), augmentation index, pulse wave velocity, and brachial distensibility (BrachD). Results: Nearly 50% of youth were diagnosed with prediabetes by HbA1c. Youth with prediabetes had worse metabolic profiles with higher BMI z score, systolic blood pressure, and fasting insulin; increased carotid IMT; and lower BrachD compared with normal glucose-tolerant youth (P < .05). Multivariate regression analysis found prediabetes was a significant determinant of internal carotid IMT and BrachD (P < .05). After excluding youth diagnosed by HbA1c, the prediabetes group was borderline significant for internal carotid IMT (.1 > P ≥ .05) only. Conclusions: Youth with prediabetes have worse cardiometabolic risk factors and evidence of increased arterial thickness and stiffness. Interventions to prevent prediabetes are crucial to reduce the development of early arterial disease.