7.1-O1Ethnic differences in the development of cardiovascular disease risk factors in children and young people with type 1 diabetes – a prospective longitudinal study in the UK

Abstract

Objective: Cardiovascular disease (CVD) is a leading cause of death in diabetes with significant ethnic differences. CVD risk factors develop in childhood and are modifiable. We studied development of CVD risk factors from diagnosis of type 1 diabetes (T1D) in a multi-ethnic cohort of children and young people (CYP). Methods: All CYP diagnosed with T1D attending three pediatric clinics in London (2005-2015) were included. Clinical and demographic information was collected prospectively during routine check-ups. Linear longitudinal mixed effects modeling was used to analyze ethnic (White, Mixedethnicity, Black, Somali, Bangladeshi and Asian) differences in trajectories of risk factors (BMI, blood pressure [BP], lipids and albumin-creatinineratio [ACR]) from diagnosis (adjusting for age, gender and clinic). Results: 565 children were included (48% males, 60% non-white). Mean age at diagnosis was 8.5 years (range 0.9-19.4) and diabetes duration was 4.3 years (0-10.8). 33% of measures showed unhealthy BMI (Zscores ≥ 85th percentile), 15% showed microalbuminuria, 66% were above total cholesterol targets and 5% reached LDL treatment thresholds. Mean BMI was highest in Black (21 kg/m2) and Bangladeshi CYP (20.3 kg/m2 Vs. 19.7 kg/m2 in White). Black and Asian groups had higher BP (p < 0.001). Following diagnosis, there were significant annual increases in BMI (adjusted estimates 1.4 kg/m2, 95% CI 0.5-2.3) in Somali and total cholesterol (0.35 mmol/mol, 0.2-0.7, Figure) and LDL (0.35 mmol/mol, 0.12-0.58) in Bangladeshi compared to White CYP. Black CYP had significant annual increases of triglycerides (0.14 mmol/ mol, 0.25-0.01) and ACR (0.5, 0.66-0.28) compared toWhite. Conclusions: CYP with T1D have higher prevalence of CVD risk factors, with worse profiles in Black and Bangladeshi groups. This supports findings of increased CVD risk in ethnic minorities with and without diabetes. Tailored interventions for ethnic minority CYP with T1D are needed to preserve CV health in adult life.