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

for the TODAY Study Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.gov NCT00081328.

Original languageEnglish (US)
Pages (from-to)86-92.e5
JournalJournal of Pediatrics
Volume192
DOIs
StatePublished - Jan 1 2018

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Type 2 Diabetes Mellitus
Biomarkers
Troponin
Tumor Necrosis Factor Receptors
Brain Natriuretic Peptide
Body Mass Index
Serum
Receptors, Tumor Necrosis Factor, Type II
Therapeutics
Left Ventricular Function
Stroke Volume
Multicenter Studies
Hemoglobins
Cardiovascular Diseases
Tumor Necrosis Factor-alpha
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{2347dde4602948bd93b54fbf23ff9635,
title = "Cardiac Biomarkers in Youth with Type 2 Diabetes Mellitus: Results from the TODAY Study",
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.gov NCT00081328.",
author = "{for the TODAY Study Group} and Gidding, {Samuel S.} and Fida Bacha and Petter Bjornstad and {Levitt Katz}, {Lorraine E.} and Levitsky, {Lynne L.} and Jane Lynch and Tryggestad, {Jeanie B.} and Weinstock, {Ruth S.} and {El ghormli}, Laure and Lima, {Joao A.C.} and S. McKay and M. Haymond and B. Anderson and C. Bush and S. Gunn and H. Holden and Jones, {S. M.} and G. Jeha and S. McGirk and S. Thamotharan and L. Cuttler and E. Abrams and T. Casey and W. Dahms and C. Ievers-Landis and B. Kaminski and M. Koontz and S. MacLeish and P. McGuigan and S. Narasimhan and M. Geffner and V. Barraza and N. Chang and B. Conrad and D. Dreimane and S. Estrada and L. Fisher and E. Fleury-Milfort and S. Hernandez and B. Hollen and F. Kaufman and E. Law and V. Mansilla and D. Miller and C. Mu{\~n}oz and R. Ortiz and A. Ward and K. Wexler and Xu, {Y. K.} and P. Yasuda",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpeds.2017.09.012",
language = "English (US)",
volume = "192",
pages = "86--92.e5",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

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

In: Journal of Pediatrics, Vol. 192, 01.01.2018, p. 86-92.e5.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiac Biomarkers in Youth with Type 2 Diabetes Mellitus

T2 - Results from the TODAY Study

AU - for the TODAY Study Group

AU - Gidding, Samuel S.

AU - Bacha, Fida

AU - Bjornstad, Petter

AU - Levitt Katz, Lorraine E.

AU - Levitsky, Lynne L.

AU - Lynch, Jane

AU - Tryggestad, Jeanie B.

AU - Weinstock, Ruth S.

AU - El ghormli, Laure

AU - Lima, Joao A.C.

AU - McKay, S.

AU - Haymond, M.

AU - Anderson, B.

AU - Bush, C.

AU - Gunn, S.

AU - Holden, H.

AU - Jones, S. M.

AU - Jeha, G.

AU - McGirk, S.

AU - Thamotharan, S.

AU - Cuttler, L.

AU - Abrams, E.

AU - Casey, T.

AU - Dahms, W.

AU - Ievers-Landis, C.

AU - Kaminski, B.

AU - Koontz, M.

AU - MacLeish, S.

AU - McGuigan, P.

AU - Narasimhan, S.

AU - Geffner, M.

AU - Barraza, V.

AU - Chang, N.

AU - Conrad, B.

AU - Dreimane, D.

AU - Estrada, S.

AU - Fisher, L.

AU - Fleury-Milfort, E.

AU - Hernandez, S.

AU - Hollen, B.

AU - Kaufman, F.

AU - Law, E.

AU - Mansilla, V.

AU - Miller, D.

AU - Muñoz, C.

AU - Ortiz, R.

AU - Ward, A.

AU - Wexler, K.

AU - Xu, Y. K.

AU - Yasuda, P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.gov NCT00081328.

AB - 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.gov NCT00081328.

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DO - 10.1016/j.jpeds.2017.09.012

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