Alterations in left ventricular, left atrial, and right ventricular structure and function to cardiovascular risk factors in adolescents with type 2 diabetes participating in the TODAY clinical trial
Open accessAbstract
Data on cardiovascular disease (CVD) risk in adolescents with type 2 diabetes (T2D) are limited. Echocardiography was performed in the last year of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial (median 4½ yr from diagnosis of T2D, average age 18 yr), including MMode and 2D measurements of left ventricular (LV) and left atrial (LA) dimensions, LV tissue Doppler imaging (TDI), and tricuspid annular plane systolic excursion (TAPSE). Relationships between cardiac structure and function with demographic characteristics and baseline and change-from-baseline in CVD risk factors were examined in 455 participants. Mean LV mass (LVM) was high/normal and 16.2% had adverse LV geometry (8.1% concentric geometry, 4.5% LV hypertrophy, and 3.6% both). Determinants of higher LVM were male gender, black race, baseline and increasing body mass index (BMI), baseline and increasing systolic blood pressure (SBP), use of blood pressure (BP) medications, maintenance of glycemic control, and smoking; heart rate (HR) was inversely related. LV shortening fraction was high/normal and related to increasing BMI and higher baseline SBP. LV relative wall thickness was related to race-ethnicity, change in BMI, baseline glycated hemoglobin (HbA1c), and baseline and change in SBP. Mean LA internal dimension was high/normal and gender, baseline and increasing BMI, increasing SBP, and HR (inverse) were related. LV TDI was positively related to obesity (higher with adverse geometry). TAPSE was normal and related to higher baseline BMI and lower HR. There was no effect of T2D treatment on cardiac target organ injury. Adolescents with T2D have adverse measures of cardiac structure and function positively related to BMI and BP.
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Rising rates of obesity and type 2 diabetes in adolescents put these youth at greater risk of cardiovascular disease as they age.
“The rising rates of obesity and T2D in adolescents put these youth at greater risk of CVD as they age [20,21,22].”
From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [22]
The Discussion (page unavailable) links obesity and other risk factors in adolescents with T2D to early cardiac abnormalities and describes a high likelihood of future cardiovascular morbidity and mortality. It does not establish that rates of adolescent obesity or T2D are rising, so that part of the cited sentence is unsupported. (LLM, conf=0.86)
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Metabolic outcomes of surgery in youth with type 2 diabetes
SHAH, A. S., Nadeau, K. J., Helmrath, M. A., Inge, T. H., Xanthakos, S. A., & Kelsey, M. M. (2020) · Seminars in Pediatric Surgery · doi:10.1016/j.sempedsurg.2020.150893 · Cited by 9 · see citing works
Sellers, E. A. C., Dart, A. B., McGavock, J., & Wicklow, B. A. (2021) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2021.04.002 · Cited by 8 · see citing works
Guillemette, L., Dart, A. B., Wicklow, B. A., Dolinsky, V. W., Cheung, D. Y. C., Jassal, D. S., Sellers, E. A. C., Gelinas, J. C., Eves, N. D., Balshaw, R. F., et al. (2019) · Pediatric Diabetes · doi:10.1111/pedi.12954 · Cited by 7 · see citing works
Youth-Onset Type 2 Diabetes and the Developing Brain
Redel, J. M., Dolan, L. M., DiFrancesco, M. W., Vannest, J. J., & SHAH, A. S. (2019) · Current Diabetes Reports · doi:10.1007/s11892-019-1120-y · Cited by 7 · see citing works
Effects of body mass index and gender on left atrial size in Chinese hypertensive patients
Chen, X., Wu, M., Xu, K., Huang, M., & Xu, H. (2020) · Clinical and Experimental Hypertension · doi:10.1080/10641963.2020.1779285 · Cited by 6 · see citing works
Saedi, S., Tan, Y., Watson, S. E., Sparks, J. D., Wintergerst, K. A., & Cai, L. (2025) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00673.2024 · Cited by 6 · see citing works
Thiazolidinediones Cause Cardiotoxicity via PPARγ- Independent Mechanism
Jiang, J., Balschi, J. A., McGowan, F. X. J., & He, H. (2018) · InTech eBooks · doi:10.5772/intechopen.78957 · Cited by 5 · see citing works
Lipids: a Potential Molecular Pathway Towards Diastolic Dysfunction in Youth-Onset Type 2 Diabetes
SHAH, A. S., Sadayappan, S., & Urbina, E. M. (2022) · Current Atherosclerosis Reports · doi:10.1007/s11883-022-00989-w · Cited by 6 · see citing works
Roles of cMyBP-C phosphorylation on cardiac contractile dysfunction in db/db mice
Desai, D. A., Baby, A., Ananthamohan, K., Green, L. C., Arif, M., Duncan, B. C., Kumar, M., Singh, R. R., Koch, S. E., Natesan, S., et al. (2024) · Journal of Molecular and Cellular Cardiology Plus · doi:10.1016/j.jmccpl.2024.100075 · Cited by 5 · see citing works
Yoshida, Y., Zu, Y., Fan, B., Li, S., Yoshida, T., Harville, E. W., Zhang, T., Bae, S., Shikany, J. M., & Fonseca, V. A. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15681 · Cited by 5 · see citing works
Muñoz, P. A., Celermajer, D. S., Gu, Y., Bradley, S., Wong, J., Constantino, M., McLennan, S., Lau, E., Alison, J. A., & Harmer, A. R. (2024) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2024.11.003 · Cited by 5 · see citing works
Type 2 diabetes in youth: Rationale for use of off‐label antidiabetic agents
Kelsey, M. M., Zeitler, P. S., Nadeau, K. J., & SHAH, A. S. (2022) · Pediatric Diabetes · doi:10.1111/pedi.13350 · Cited by 5 · see citing works
Vidmar, A. P., Batt, C. E., & Moore, J. M. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.10.008 · Cited by 5 · see citing works
Ioannou, M., Karelas, D., Kalesi, A. E., Parpas, G., Papanastasiou, C. A., Papadopoulos, C. H., Mouzarou, A., & Kadoglou, N. P. E. (2025) · Diagnostics · doi:10.3390/diagnostics15202587 · Cited by 3 · see citing works
Ménanga, A., Nganou–Gnindjio, C. N., Lade, V., Ahinaga, A. J., Franck, N., Wafeu, G. S., Tchapmi, D., Bâ, H., & Kingué, S. (2020) · World Journal of Cardiovascular Diseases · doi:10.4236/wjcd.2020.1010068 · Cited by 3 · see citing works
Vascular and Myocardial Structure and Function in Adolescents with Type 1 Diabetes: The CARDEA Study
Harnois‐Leblanc, S., McNealis, V., Friedrich, M. G., Bigras, J., Hulst, A. V., Nuyt, A. M., Barnett, T. A., Benedetti, A., Mathieu, M.-E., Drapeau, V., et al. (2023) · Pediatric Diabetes · doi:10.1155/2023/8662038 · Cited by 1 · see citing works
Exercise Performance in Youth with Diabetes
Gross, S. P., Baumgartner, A., & Nadeau, K. J. (2017) · Contemporary diabetes · doi:10.1007/978-3-319-61013-9_5 · Cited by 1 · see citing works
Type 2 Diabetes Mellitus in Youth
Srinivasan, S., & Levitsky, L. L. (2018) · Springer eBooks · doi:10.1007/978-3-319-73782-9_32 · Cited by 1 · see citing works
Obesity is Associated with Increased Left Ventricular Mass in Children
Safdar, O. Y., Shalaby, M., Elsafi, E., Sabir, M. E., Alghamdi, L. A., Banjar, L. A., Kurdi, H. S., Ghunaim, A. H., NoorSaeed, S. M., Zaher, Z. F., et al. (2016) · Journal of Obesity and Overweight · doi:10.15744/2455-7633.2.104
Factors affecting the left atrial diameter
Beşir, Y. (2017) · The Anatolian Journal of Cardiology · doi:10.14744/anatoljcardiol.2017.7909
Pinhas‐Hamiel, O., Zeitler, P. S., & Kelsey, M. M. (2017) · Contemporary Endocrinology · doi:10.1007/978-3-319-68192-4_24
Managing type 2 diabetes in children and young people: challenges and solutions
Wilson, V. (2023) · Nursing Children and Young People · doi:10.7748/ncyp.2023.e1460
Type 2 Diabetes Mellitus in Youth
Srinivasan, S., & Levitsky, L. L. (2024) · Springer eBooks · doi:10.1007/978-3-031-66296-6_31
Flores, C. H., Flores, J. H., & Sanchez, P. L. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-34260-8.00008-5
SHAH, A. S., Isom, S. P., Dabelea, D., D’Agostino, R., Dolan, L. M., Wagenknecht, L., Imperatore, G., Saydah, S., Liese, A. D., Lawrence, J. M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14927114
Cardiovascular Risk Stratification in Youth-Onset Type 2 Diabetes Using Machine Learning
Joo, E. Y., Lee, Y. S., Shin, E. J., Kim, S. J., & Lee, J. (2025) · Journal of Korean Medical Science · doi:10.3346/jkms.2026.41.e4
- Authors
- TODAY Study Group
- Affiliations
- George Washington University (US)
- Corresponding author
- TODAY Study Group
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2014-01-22
- Volume
- 16
- Issue
- 1
- Pages
- 39-47
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- PMC
- PMC4107202
- OpenAlex
- W107858103
- Cited by
- 77
- References
- 35
- Citations by year
- 2025: 5 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 4 · 2020: 11 · 2019: 10 · 2018: 8 · 2017: 5 · 2016: 9 · 2014: 4
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Pediatric Diabetes (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (U01-DK61230)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- cardiovascular risk factors, left ventricular hypertrophy, left ventricular mass, left atrial size, right ventricular function, tissue Doppler imaging, tricuspid annular plane systolic excursion, body mass index, systolic blood pressure, obesity, glycemic control, heart rate
- MeSH terms
- Adolescent, Cardiovascular Diseases, Child, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Echocardiography, Female, Heart Atria, Heart Ventricles, Humans, Male, Metformin, Risk Factors, Atrial Function, Left, Hypertrophy, Left Ventricular, Ventricular Dysfunction, Diabetic Cardiomyopathies
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