58-OR: Diastolic Dysfunction, a Precursor for Heart Failure in Young Adults with Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study

Individuals with diabetes are at high risk for heart failure with preserved ejection fraction due to diabetic cardiomyopathy (DCM), defined as abnormal myocardial structure and function in the absence of overt coronary artery disease. DCM leads to myocardial fibrosis and remodeling with one of the first signs being left ventricular (LV) diastolic dysfunction. The objective was to compare the prevalence of diastolic dysfunction among young adults with type 1 diabetes (T1D) vs. type 2 diabetes (T2D) with diabetes diagnosed in childhood. Participants had T1D or T2D and were enrolled in the SEARCH for Diabetes in Youth Study. Cardiovascular risk factors and diastolic function via echocardiography were measured at an in-person visit, after an average disease duration of 10.9 years (both groups). Unadjusted means were compared between those with T1D and T2D, p <0.05 indicating significance. Diastolic dysfunction was defined as abnormal LV filling volume, LV pressure, or transmitral velocity, based on published norms for age. Of 458 eligible participants, 255 had T1D (mean age 21.2±5.2 years, 60.8% non-Hispanic white, 54.1% female, mean A1c 9.0±1.9%), and 203 had T2D (mean age 24.3±4.3 years, 24.1% non-Hispanic white, 75.4% female, mean A1c 9.6±3.0%). Participants with T2D had a worse cardiovascular risk profile (higher BMI, systolic and diastolic BP, triglycerides, LDL-C, A1c and lower HDL-C) than those with T1D, all p<0.05. Participants with T2D also had lower LV filling volume, transmitral velocity and higher LV pressure, all p<0.05, than those with T1D, suggesting worse diastolic function. The unadjusted prevalence of diastolic dysfunction was high in both groups (57.7% in T2D vs. 47.2% in T1D; p<0.05). Diastolic function is worse in individuals with T2D compared to T1D, but diastolic dysfunction is high in both groups. These findings support monitoring of young adults with diabetes for development of heart-related complications.