Lipid and inflammatory cardiovascular risk worsens over 3 years in youth with type 2 diabetes: The TODAY clinical trial.

Authors

Ruth S. Weinstock, State University of New York Upstate Medical UniversityFollow
Sonia Caprio, Yale University
Kenneth C. Copeland, University of OklahomaFollow
Samuel S. Gidding, Nemours Cardiac Center
Kathryn Hirst, George Washington University
Lorraine L. Katz, Children's Hospital of PhiladelphiaFollow
Santica M. Marcovina, Northwest Lipid Research LaboratoriesFollow
Kristin J. Nadeau, University of Colorado at Denver
David M. Nathan, Massachusetts General Hospital

Document Type

Journal Article

Publication Date

6-2013

Journal

Diabetes Care

Volume

Volume 36, Issue 6

Inclusive Pages

1758-1764

Keywords

Cardiovascular Diseases--blood; Diabetes Mellitus, type 2--blood; Inflammation--blood; Lipids--blood

Abstract

OBJECTIVE:

Type 2 diabetes increases cardiovascular risk. We examined lipid profiles and inflammatory markers in 699 youth with recent-onset type 2 diabetes in the TODAY clinical trial and compared changes across treatment groups: metformin alone (M), metformin plus rosiglitazone (M+R), and metformin plus intensive lifestyle program (M+L).

RESEARCH DESIGN AND METHODS:

Multiethnic youth with type 2 diabetes received M, M+R, or M+L. Statin drugs were begun for LDL cholesterol (LDL) ≥ 130 mg/dL or triglycerides ≥ 300 mg/dL. Lipids, apolipoprotein B (apoB), LDL particle size, high-sensitivity c-reactive protein (hsCRP), homocysteine, plasminogen activator inhibitor-1 (PAI-1), and HbA1c were measured over 36 months or until loss of glycemic control.

RESULTS:

LDL, apoB, triglycerides, and non-HDL cholesterol (HDL) rose over 12 months and then stabilized over the next 24 months. Participants with LDL ≥ 130 mg/dL or using LDL-lowering therapy increased from 4.5 to 10.7% over 36 months, while 55.9% remained at LDL goal (<100 mg/dL) over that time. Treatment group did not impact LDL, apoB, or non-HDL. Small dense LDL (particle size, ≤ 0.263 relative flotation rate) was most common in M. Triglycerides were lower in M+L than M, and M+L attenuated the negative effect of hyperglycemia on triglycerides and HDL in females. hsCRP, PAI-1, and homocysteine increased over time. However, hsCRP was lower in M+R compared with M or M+L.

CONCLUSIONS:

Dyslipidemia and chronic inflammation were common in youth with type 2 diabetes and worsened over time. Diabetes treatment, despite some treatment group differences in lipid and inflammatory marker change over time, is generally inadequate to control this worsening risk.

Comments

Reproduced with permission of the American Diabetes Association. Diabetes Care.

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

APA Citation

Weinstock, R. S., Caprio, S., Copeland, K. C., Gidding, S. S., Hirst, K., Katz, L. L., . . . Nathan, D. M. (2013). Lipid and inflammatory cardiovascular risk worsens over 3 years in youth with type 2 diabetes: The TODAY clinical trial. Diabetes Care, 36(6), 1758-1764.

Peer Reviewed

1

Open Access

1