1. Dr Stephanie Jones, Dr Amal Khanolkar, Dr Krystyna Matyka,
Development of cardiovascular risk factors in children with type 1 diabetes A longitudinal cohort study
Dr Stephanie Jones, Dr Amal Khanolkar, Dr Krystyna Matyka,
Dr Evelien Gevers, Dr Jeremy Allgrove, Prof Terence Stephenson, Dr Rakesh Amin

2. BACKGROUND
Cardiovascular disease (CVD) is the leading cause of death in adults with diabetes
Atherosclerosis begins in childhood and progression correlates to modifiable risk factors:
Incidence of CVD varies between ethnicities
Obesity Hypertension Dyslipidaemia Poor diet
Reduced Exercise Psychosocial factors Smoking Alcohol

3. PROJECT AIMS:
AIMS
To understand the characteristics and prevalence of cardiovascular risk factors in a longitudinal cohort of children with Type 1 diabetes
To understand the relationship of these risk factors with increasing disease duration
To look for differences between ethnic groups

4. METHODS Patient Sample Outcomes of Interest
Body Mass Index (BMI)
Blood Pressure (BP)
Lipids (Total cholesterol, LDL, HDL, triglycerides)
All children diagnosed and attending routine clinics at Barts NHS Trust between (n = 565)

5. METHODS Data Analysis Prospective collection
Comparisons made between covariates and age/ethnicity
Longitudinal mixed effects models accounting for covariates were undertaken:
Model 1: Diabetes Duration
Model 2: Age Gender Ethnicity
Diabetes Clinic
Model 3: HbA1c
Model 4: Height (BP only)

6. Patients PATIENTS Mean age at diagnosis 8.5 years (0.6 - 19.4)
Mean length of follow up 4.3 years ( )
52% were boys
60% were non-White
Mean HbA1c 70.8mmol/mol (8.6%)
Average 4 contacts/year (1-14)
BMI BP
Lipid
N (%)
535 (94.7)
463 (82)
377 (66.7)
Mean age in years at first measure [SD]
9.3 [4.3]
9.9 [4.2] *
10.6 [4.3] *
Measures/ year (range)
3 (1-9)
3 (1-8)
1 (1-3)
* p<0.001 (variation between diabetes clinics)

7. RESULTS At diagnosis: BMI Sys BP Dias BP T.chol LDL All 19.0 [3.8]
(kg/m2)
(mmHg)
(mmol/mol)
All
19.0 [3.8]
106 [11]
61 [8]
4.2 [0.9]
2.3 [0.7]
SDS
0.6 [1.1]
-0.5 [1.1]
0.4 [0.9]

8. RESULTS At diagnosis: BMI Sys BP Dias BP T.chol LDL All 19.0 [3.8]
(kg/m2)
(mmHg)
(mmol/mol)
All
19.0 [3.8]
106 [11]
61 [8]
4.2 [0.9]
2.3 [0.7]
White
19.1 [3.5]
62 [9]
4.2 [0.8]
2.2 [0.7]
Mixed
18.2 [3.1]
104 [12]
59 [7]
4.2 [1.0]
2.4 [0.8]
Somali
18.3 [3.6]
102 [11]
58 [5]
4.1 [0.9]
2.0 [0.6]
Black Other
20.5* [3.9]
109 [10]
60 [6]
4.3 [1.0]
2.4 [0.7]
Bangladeshi
20.5* [3.5]
2.5 [0.7]
Asian Other
18.4 [4.4]
107 [13]
63 [10]
4.0 [0.9]
2.1 [0.8]
* P <0.05, ** p <0.01

9. RESULTS At follow up (4 years): BMI Sys BP Dias BP T.chol LDL All
(kg/m2)
(mmHg)
(mmol/mol)
All
19.0 [3.8]
106 [11]
61 [8]
4.2 [0.9]
2.3 [0.7]
White
19.1 [3.5]
62 [9]
4.2 [0.8]
2.2 [0.7]
f/u
Mixed
18.2 [3.1]
104 [12]
59 [7]
4.2 [1.0]
2.4 [0.8]
Somali
18.3 [3.6]
102 [11]
58 [5]
4.1 [0.9]
2.0 [0.6]
Black Other
20.5* [3.9]
109 [10]
60 [6]
4.3 [1.0]
2.4 [0.7]
Bangladeshi
20.5* [3.5]
2.5 [0.7]
Asian Other
18.4 [4.4]
107 [13]
63 [10]
4.0 [0.9]
2.1 [0.8]
19.9 [3.8] [0.7]
9.9 [4.6] [0.6]
16.9 [3.5]** [-]
21.8* [12.7] [1.3]
20.5 [3.7] * [0.9]
19.8 [3.8] [0.4]
* P <0.05, ** p <0.01

10. RESULTS
Percentage of measurements above target values

11. RESULTS – Longitudinal Models
Fully adjusted models demonstrated small annual increments with increasing diabetes duration*
Lipids in keeping with large American cohort
(Shah et al 2017)
Subgroup (>12 years) analysis demonstrated similar results‡
HbA1c effected all variables other than BP*
BMI (0.6 kg/m2)
BP (2 mmHg / 0.07 SDS)
T.chol (0.02 mmol/mol)
LDL (0.02 mmol/mol)
HDL (0.03 mmol/mol)
‡ NS, * p<0.001

12. RESULTS – Longitudinal Models
There was significant variation between ethnicities:
Black children had the greatest rise in BMIϮ (1.6 kg/m2)
Bangladeshi children had the most clinically significant riseϮ (T.chol & LDL 0.3 mmol/mol)
Ϯ p<0.01

13. CONCLUSIONS
This study identified high numbers of abnormal measures of modifiable risks for CVD in children with Type 1 Diabetes
Most outcomes rose with increasing disease duration and is associated with poor glycaemic control.
There were significant ethnic differences in the association between risk factors and disease duration

15. RESULTS
There was no significant difference between measures taken before or after 12 years
* p <0.001

16. BMI Sys BP Dias BP T.chol All
(kg/m2)
(mmHg)
(mmol/mol)
All
19.7 [4.1]
110 [12]
64 [9]
4.3 [0.9]
Boys
19.2 [3.5]
111 [12]
63 [8]
Girls
20.1* [4.5]
110 [11]
64* [9]
4.4 [0.84]
White
19.7 [4.0]
4.3 [0.8]
Mixed
19.0* [3.5
107* [11]
62* [8]
4.2 [0.8]
Somali
18.2* 3.6]
105 [11]
60* [8]
4.2 [0.9]
Black Other
21.0* [3.9]
113* [12]
Bangladeshi
20.3* [4.4]
109* [13]
4.8* [1.0]
Asian Other
19.4 [4.2]
67* [10]
Bold = p<0.05, * = p <0.001