Glycemic and nonglycemic effects of pediatric diabetes in cardiovascular health

In children and adolescents, the most common cause of diabetes mellitus is type 1 diabetes, but type 2 diabetes is increasing in prevalence. Cardiovascular disease is the leading cause of morbidity and mortality in people with diabetes and begins in childhood. The purpose of this article is to review cardiovascular disease associated with type 1 and type 2 diabetes in children and adolescents, including glycemic and nonglycemic risk factors, screening, and therapy. The risk of developing cardiovascular disease is 30-fold higher in patients with type 1 diabetes than in nondiabetic peers and 32 % of patients with type 2 diabetes have some type of cardiovascular disease. The risk for developing cardiovascular disease is affected by uncontrolled hyperglycemia, hypertension, dyslipidemia, diabetic kidney disease, obesity, and insulin resistance. The pathophysiology of cardiovascular disease in patients with diabetes is multifactorial and includes hyperglycemia, oxidative stress, hypoglycemia, advanced glycation end products, inflammation, endothelial dysfunction, dyslipidemia, renin-angiotensin-aldosterone system activation, and insulin resistance. Macrovascular complications include coronary heart disease, peripheral artery disease, and diabetic cardiomyopathy. Microvascular complications include diabetic retinopathy, kidney disease, and neuropathy. Advances in treatment of type 1 and type 2 diabetes have decreased overall adult mortality, but pharmacologic therapeutic options are limited in children and adolescents, including insulin, metformin, glucagon-like peptide 1 analogs, dipeptidyl peptidase 4 inhibitors, and sodium-glucose cotransporter 2 inhibitors. Patient education, diet, and physical activity are important for prevention of cardiovascular disease. Screening for cardiovascular risk factors may include measurement of blood pressure, body mass index, hemoglobin A1c level, lipid panel including low-density lipoprotein level, and albumin-to-creatinine ratio in urine. •Cardiovascular disease is the leading cause of death in patients with diabetes.•There are glycemic and nonglycemic risk factors for cardiovascular disease.•Elevated hemoglobin A1c level is associated with worse cardiovascular outcomes.•Risk factors include hypertension, obesity, and elevated LDL level.•Early screening and interventions to improve glycemic control are important.