Longitudinal changes in vascular stiffness and heart rate variability among young adults with youth-onset type 2 diabetes: results from the follow-up observational treatment options for type 2 diabetes in adolescents and youth (TODAY) study

Abstract

Aims: (1) To describe changes in arterial stiffness and heart rate variability (HRV) over a 5-year interval, (2) examine changes by sex and race-ethnicity, and (3) evaluate the risk factors associated with the longitudinal changes in arterial stiffness and HRV.

Methods: Participants with youth-onset type 2 diabetes enrolled in the observational follow-up phase of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial had arterial stiffness [(pulse wave velocity, augmentation index, brachial distensibility] and six indices of HRV measured 5 years apart. Multivariable linear regression models assessed risk factors associated with changes in the outcomes over time.

Results: At initial vascular assessment, the 304 participants were a mean age of 21 years, 34% male, and had a mean diabetes duration of 8 years. In more than half the cohort pulse wave velocity, augmentation index and HRV increased over 5 years (p<0.01). Brachial distensibility did not change. There were no differences in the 5-year change by race/ethnicity except for a single HRV measure, where non-Hispanic Blacks had greater worsening of parasympathetic function compared to non-Hispanic Whites, p = 0.008. Blood pressure was related to greater worsening in augmentation index and pulse wave velocity. Higher hemoglobin A1c over time was related to worsening pulse wave velocity and HRV.

Conclusions: Arterial stiffness and HRV worsened over 5 years. Blood pressure and glycemic control may be potential targets to influence adverse changes in arterial stiffness and HRV in young adults with youth-onset type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT00081328.

Keywords: Arterial stiffness; Heart rate variability; Risk factors; Type 2 diabetes.

Conflict of interest statement

Declarations

Conflict of interest The authors declare that they have no competing interests to report.

© 2021. Springer-Verlag Italia S.r.l., part of Springer Nature.

Figures

Figure 1.

Arterial Stiffness (Panel A) and Heart Rate Variability (Panel B) Outcomes in the TODAY Participants (N=304) at the Initial (2013–2014) and 5-Year Follow-Up (2018–2019) Assessment* Panel A: Mean ± SD at initial and 5-year follow-up assessment for the arterial stiffness measures. Panel B: median [25th −75th percentile] at initial and 5-year follow-up assessment for the heart rate variability measures. SDNN: SD of the NN intervals; RMSSD: root mean square differences of successive NN intervals; PNN50: percent of adjacent NN intervals with a difference greater than 50msec; n.u.normalized units. * P-value testing paired differences between the initial vs. the 5-year follow-up assessment, using at-test for continuous measures from adjusted models for age, sex, and race-ethnicity. Higher value is worse for all arterial stiffness measures except brachial distensibility, for low frequency, and for low frequency/high frequency ratio; Lower value is worse for all others.