May Predispose Type 2 Diabetes, Cardiovascular Disease
BOSTON - February 27, 2008 - Overweight Hispanic children with normal blood
glucose (sugar) levels showed elevated markers for blood vessel inflammation
that may predispose them to developing both type 2 diabetes and cardiovascular
disease, says a new study led by researchers from the Joslin Diabetes Center.
The study, published in the March issue of Diabetes Care, is the first to focus
on Hispanic children, already known to be at high risk for developing type
2 diabetes as a result of both genetic and lifestyle factors.
“Our findings suggest that these children are not only at risk for type
2 diabetes, but also for cardiovascular disease,” said Dr. A. Enrique
Caballero, lead investigator, and an assistant professor at Harvard Medical
School.
The study looked at 38 Hispanic children and adolescents, ages 10 through 18.
Twenty-one were obese but with normal blood glucose levels, so they had not
yet developed diabetes. The rest were considered lean. As a group, the obese
subjects had significantly higher percentages of body fat than the lean group
and were already showing signs of insulin resistance, meaning the insulin that
their bodies produce is not working well and as a consequence their pancreases
were being forced to work harder to produce more insulin to maintain normal
blood sugar levels.
Overall, the obese group exhibited increased blood markers for subclinical
or asymptomatic inflammation of the inner layer of blood vessels. “They
are already exhibiting problems with circulation,” said Caballero, Director
of the Latino Diabetes Initiative, Clinical Investigator, Staff Endocrinologist
and Director, Medical Affairs, Professional Education at Joslin Diabetes Center,
as well as an Assistant Professor of Medicine at Harvard Medical School. “There
is an inflammatory process going on in the vessels.”
Such problems suggest these children may be at increased risk of developing
cardiovascular problems at a young age, he said.
Subclinical vascular inflammation is a key element in the development of cardiovascular
disease and is closely associated with insulin resistance. It also predicts
the development of type 2 diabetes.
Earlier studies in overweight or obese children and adolescents showed similar
vascular abnormalities, but were conducted primarily in non-Hispanic children.
Caballero wanted to study Hispanic children because they had not previously
been studied and because they are a high-risk population for type 2 diabetes.
“We have found that overweight Hispanic children and adolescents have
elevated markers of endothelial dysfunction and vascular inflammation closely
related to excess body fat and increased insulin resistance,” the paper
concluded. “This. . . may increase their risk of developing type 2 diabetes
and cardiovascular disease, further emphasizing the need for obesity prevention
strategies.”
Caballero said such strategies must be culturally appropriate.
“Even if these abnormalities may not be that different than those in
Caucasian children, the strategies to prevent heart disease and diabetes need
to be culturally oriented,’’ he said. “They need to be tailored
to the population.”
Caballero stressed that the findings do not mean that such children will definitely
develop type 2 diabetes or cardiovascular problems, but said the idea is to
step in early to make sure they don’t.
“The problem is serious enough to warrant attention and a prevention
strategy,” he said.
The research was funded by a grant from Sanofi Aventis and a National Institutes
of Health grant for general clinical research at Beth Israel Deaconess Medical
Center.
In addition to Dr. Caballero, other researchers participating in the study
included: Dr. Ludivina Robles-Osorio, Valeria Montagnani, RN, Dr. Geetha Soodini,
Dr. Sriurai Porramatikul, Dr. Osama Hamdy and Dr. Edward S. Horton from the
Joslin and Kelb Bousquet-Santos and Dr. Antonio C.L. Nobrega from Fluminense
Federal University in Brazil.
About the Latino Diabetes Initiative
The Latino Diabetes Initiative at Joslin Diabetes Center, directed by Dr. Caballero,
is a comprehensive effort to improve the lives of Latinos who have or are
at risk of developing diabetes. This initiative integrates a culturally oriented
clinical care and patient education program, community outreach activities,
professional education programs and a clinical research program. Additional
information is available at http://www.joslin.org/3250.asp.
Joslin Diabetes Center is the world’s largest diabetes clinic, diabetes research center and provider of diabetes education. Founded in 1898, Joslin is an independent nonprofit institution affiliated with Harvard Medical School. Joslin research is a team of more than 300 people at the forefront of discovery aimed at preventing and curing diabetes. Joslin Clinic, affiliated with Beth Israel Deaconess Medical Center in Boston, the nationwide network of Joslin Affiliated Programs, and the hundreds of Joslin educational programs offered each year for clinicians, researchers and patients, enable Joslin to develop, implement and share innovations that immeasurably improve the lives of people with diabetes. As a nonprofit, Joslin benefits from the generosity of donors in advancing its mission.