Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes
Abstract
:1. Introduction
2. Cardiovascular Risk Factors in Type 1 Diabetes Youths and the Role of Sex
2.1. Hormonal Factors
2.2. Hyperglycemia
2.3. High Blood Pressure
2.4. Albuminuria
2.5. Dyslipidemia
2.6. Obesity and Insulin Resistance
2.7. Chronic Inflammation
2.8. Lifestyle, Diet and Psychosocial Factors
2.8.1. Physical Inactivity
2.8.2. Unhealthy Diet
2.8.3. Eating Disorders
2.8.4. Smoking
2.8.5. Psychosocial Factors
3. Sex and Cumulative Number of Risk Factors
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Type of CVD Risk Factor | CVD Risk Factor | Sex-Related | Sex with Higher Overall Burden (Degree) 1 | Study (Sex Difference Girls vs. Boys) |
---|---|---|---|---|
Nonmodifiable | Age/duration of T1D | No | NA | NA |
Family history of CVD | No | NA | NA | |
Ethnicity | No | NA | NA | |
Genetic risk factors | No | NA | NA | |
Modifiable | Hyperglycemia | Yes | Girls (++) | Schwab 2006 [70] (Girls) Gerstl 2007 [61] (Girls) Hanberger 2013 [65] (Girls) Dovc 2014 [64] Girls (Girls) McKnight 2015 [68] (Girls) Brown 2016 [20] (Girls) Samuelsson 2016 [66] (Girls) Carlsen 2016 [67] (Girls) Maiorino 2018 [69] (Girls) |
High blood pressure | Unclear | NA | Rodriguez 2010 [71] (No difference) Margeirsdottir [72] 2008 (No difference) Schwab 2006 [70] (Boys) | |
Albuminuria | Unclear | NA | Maahs 2007 [73] (Girls) Margeirsdottir 2008 [72] (No difference) Amin 2008 [74] (Girls) Salgado 2010 [75] (No difference) Raile 2007 [76] (Boys) Daniels [77] 2013 (Girls) Costacou 2018 [78] (No difference) | |
Dyslipidemia | Yes | Girls (+) | Schwab 2006 [70] (Girls) Margeirsdottir 2008 [72] (Girls) Macedoni 2018 [6] (Girls) | |
Obesity | Yes | Girls (++) | Liu 2010 [79] (Girls) de Vries [80] 2013 (Girls) Frohlich-Reiterer [81] 2014 (Girls) Szadkowska [82] 2015 (Girls) Pinhas-Hamiel [83] 2015 (Girls) Prinz 2018 [84] (Girls) Marlow [85] 2019 (Girls) Phelan 2019 [86] (Girls) | |
Chronic inflammation | Yes | Girls (+++) | MacKenzie 2009 [87] (Girls) Brown 2016 [20] (Girls) | |
Lifestyle and Psychosocial | Physical inactivity | Yes | Girls (+) | Valerio 2007 [88] (Girls) Aman 2009 [89] (Girls) Lukacs 2012 [90] (Girls) Bishop 2014 [91] (No difference) |
Smoking | Yes | Boys (++) | Hofer 2009 [92] (Boys) Reynolds 2011 [93] (Boys) | |
Unhealthy diets/eating disorders | Yes | Girls (++) | Mayer-Davis 2006 [94] (No difference) Øverby 2008 [95] (Girls) Wisting 2017 [96] (Girls) Wisting 2013 [97] (Girls) Baechle 2013 [98] (Girls) Nip 2019 [99] (Girls) | |
Unfavorable psychosocial factors | Yes | Girls (+) | Lawrence 2006 [100] (Girls) Silverstein 2015 [101] (No difference) Hagger 2016 [102] (No difference) Naughton 2014 [103] (Girls) |
Type of CVD Risk Factor | CVD Risk Factor | Screening Timing | Target | Management |
---|---|---|---|---|
Modifiable | Hyperglycemia and glucose variability | Quarterly HbA1c [109] TIR if possible [110] | HbA1c < 7% without significant hypoglycemia [109,110] TIR (3.9–10.0 mmol/L) > 70% of readings and time below range (<3.9 mmol/L) <4% of readings [112] | Intensified glucose monitoring Use of CGM Use of isCGM Intensified insulin adjustments Use of hybrid closed-loop system [109,110] |
High blood pressure | At least annually [15] At each routine visit [110] | BP < 90th percentile by age, sex and height, <120/80 ≥ 13 years [110] | BP > 90th percentile: Lifestyle intervention, ACE or ARB if BP is still elevated, if microalbuminuria is present [15] BP > 95th percentile: lifestyle intervention and ACE or ARB [15] | |
Albuminuria | At 11 years with 2–5 year diabetes duration [15] | ACR < 30 mg/g [110] | ACE or ARB when ACR ≥ 30 mg/g is documented (two of three urine samples obtained over a 6-month interval following efforts to improve glycemic control and normalize blood pressure) [15,110] | |
Dyslipidemia | At ≥2 years [110] At ≥11 years [15] | LDL-c < 2.6 mmol/L [15,110] HDL-c >1.2 mmol/L [114] TG < 0.8 mmol/L for children < 9 years of age and <1 mmol/L if >9 years of age [114] | LDL-c ≥ 2.6 mmol/L: lifestyle intervention, optimize glycemic control LDL-c ≥ 3.4 mmol/L: statins if the above interventions fail [15] | |
Obesity | Each visit | BMI < 85th percentile for age/gender [114] | Dietary changes and exercise Insulin sensitizing medications | |
Chronic inflammation | Unclear | hsCRP ≤ 1 mg/dL [115] | Optimizing glycemic control, BMI, lipid profile, BP | |
Lifestyle and Psychosocial | Physical inactivity | Each visit | At least 1h of physical activity daily and minimize sedentary activity [110,116] | Lifestyle intervention |
Smoking | Each visit | None | Education [110] | |
Unhealthy diet | At diagnosis, with annual updates [110] | Maintain ideal body weight, optimize growth and development Macronutrient distribution: carbohydrate 45% to 50% of energy (normal daily activity), fat < 35% of energy, saturated fat < 10% of energy, protein 15% to 20% of energy [117] | Nutritional education [110,117] | |
Eating disorders | Screening for eating disorders between 10 and 12 years of age [110] | None | Behavioral intervention | |
Unfavorable psychosocial factors | At diagnosis and planned intervals [118] Diabetes-related distress from 7–8 years of age [110] | None | Psychosocial interventions Behavioral interventions Antidepressant medications |
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Smigoc Schweiger, D.; Battelino, T.; Groselj, U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. Int. J. Mol. Sci. 2021, 22, 10192. https://doi.org/10.3390/ijms221910192
Smigoc Schweiger D, Battelino T, Groselj U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. International Journal of Molecular Sciences. 2021; 22(19):10192. https://doi.org/10.3390/ijms221910192
Chicago/Turabian StyleSmigoc Schweiger, Darja, Tadej Battelino, and Urh Groselj. 2021. "Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes" International Journal of Molecular Sciences 22, no. 19: 10192. https://doi.org/10.3390/ijms221910192