Abstract 13132: Relationship of Lv Mass, La Diameter, and Lv Geometry to Cardiovascular Risk Factors in the Today Cohort of Adolescents with Type 2 Diabetes (t2d)

Abstract

TODAY was a randomized trial of 3 regimens for type 2 diabetes mellitus (T2DM) management in adolescents: metformin alone, metformin + rosiglitazone, and metformin + intensive lifestyle. The primary outcome (PO) was failure to maintain glycemic control (occurred in 47%). Echocardiograms were performed in the last year of the study in 525 participants (female 65%; Hispanic 39%, Black 33%, White 21%). LV mass (indexed to height^2.7) and LA diameter (indexed to height) were at the 90^th and 75^th percentiles for adolescents, respectively. LV wall thickness was 3% above normal and shortening fraction was normal. General linear models were used to assess relationships between echo outcomes (LV mass, LA diameter, LV relative wall thickness, LV shortening fraction) and independent predictors: sex, ethnicity, reaching PO, treatment group, age at echocardiogram, time on treatment, and cardiovascular risk factors measured at baseline and follow-up (BMI, systolic BP, HbA1c, BP med use, cigarette use, and heart rate (HR) at echo). The table gives p-values for factors significant in multivariate models of echo outcomes. For LV mass, sex, race, baseline and change in BMI from baseline to time of echo study, and baseline and change in SBP were positively related, while HR was inversely related. Use of BP meds and cigarettes were positively related while reaching PO was negatively related. For LA diameter, predictors were similar except baseline SBP, BP meds, race, primary outcome, and PO were not significant and treatment group was marginally significant (lifestyle better). LV relative wall thickness was predicted by change in BMI, baseline HbA1c, and SBP. LV shortening fraction was positively related to change in BMI and baseline SBP. In conclusion, adolescents with T2D have LV target injury and this finding is most strongly related to BMI and BP. Baseline HbA1c adversely affected LV relative wall thickness.