Objective: Cardiovascular disease is two to four times greater in adults with diabetes, and is the major cause of death in this population. To better understand possible cardiovascular risks in youth with diabetes, this preliminary study explored the relationships of metabolic control and dietary consumption of saturated fats, folate, vitamins B6 and B12 to lipid profiles and homocysteine levels in youth with both type 1 and type 2 diabetes.
Design: A cross-sectional, descriptive correlational design was used to detect relationships among variables and differences between youth with type 1 versus type 2 diabetes.
Population, Sample, Setting, Years: Thirty-one adolescents with diabetes (25 type 1, mean age 16.6 ± 1.7 yrs.; 6 type 2, mean age 16.4 ± 1.9 yrs.) participated. Twenty were Caucasian, 8 were African-American, and 3 were Hispanic. Twenty-one were males and 10 were females. The sample was recruited from the outpatient pediatric diabetes center of a university-affiliated children's hospital in a large Midwestern metropolitan city in the United States.
Concept or Variables Studied Together: The variables included fasting values for hemoglobin A1c (metabolic control), total serum homocysteine, and lipid profile (cholesterol, LDL, HDL, triglycerides). Prospective three-day food records for determining average saturated fat, B6, B12, and folate intake were collected immediately prior to collecting the fasting laboratory studies.
Methods: Three-day food records were entered and analyzed for nutrient intake using Nutritionist ProTM (First DataBank, 2000) computer software program. A mean score for daily values of saturated fat, B6, B12, and folate intake was calculated. Demographic information including duration of diabetes, age, race, gender, and type of diabetes was collected from existing chart data. Laboratory assays were performed at established university-based facilities. Data were analyzed using Spearman's rho correlational analyses and Mann-Whitney U non-parametric tests of comparison.
Findings: Total serum homocysteine (tHcy) was not found to be associated with folate, B 6, B12, or metabolic control in the total sample, or for those with type 1 or type 2 diabetes. The mean values of tHcy for youth with type 1 and type 2 were 10.9 ± 2.8 µmol/L vs. 11.4 ± 3.5 µmol/L; both values were < 12 µmol/L, a currently acceptable normal limit in adolescents. Saturated fat intake was not associated with the lipid profile for either group. There was no significant difference in hemoglobin A1c between those with type 1 versus type 2 (8.6 ± 1.4 vs. 8.5 ± 2.2%). Hemoglobin A1c was positively associated with total cholesterol and inversely associated with folate (P < .05). Triglycerides and HDL were negatively associated (P=.007). Body mass index (BMI) (P=.001) and triglycerides (P=.03) were significantly higher in youth with type 2, while duration was significantly lower (P=.003).
Conclusions: Preliminary findings do not indicate elevated homocysteine levels that have been associated with cardiovascular disease for either the type 1 or type 2 groups. Dietary intake of folate, B6, or B12 were not linked to homocysteine values, nor was saturated fat related to lipid profile in this sample. However, those adolescents diagnosed with type 2 diabetes reflected characteristics typical of adults with the disorder, specifically elevated BMI and triglycerides that are risk factors for heart disease. Regardless of type of diabetes, poorer glycemic control may lead to elevated cholesterol and to lower serum folate, which may contribute to a higher tHcy level. Although, mean tHcy levels were at the upper limit of normal range, these values may be higher than non-diabetic controls.
Implications: Although dietary intake was not linked to tHcy or lipid profiles in adolescents with diabetes, improvement of glycemic control through dietary interventions may minimize associated cardiovascular risks of elevated cholesterol and lower folate. Further research to detect known cardiovascular risks in youth with diabetes is needed with larger sample sizes to determine the most effective prevention strategies.
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