Clinical Research Studies

Association between surrogates of arterial stiffness and urinary EDC in adolescents and young adults with Type 1 and Type 2 diabetes compared to age matched healthy adolescents. 2. Introduction: Diabetes is one of the leading chronic diseases in youth(1), and its incidence has been increasing worldwide(2). About 208,000 Americans under age 20 are estimated to have diagnosed diabetes (Type 1 {T1DM} or Type 2 {T2DM}), which constitutes about 0.25% of population. The SEARCH study for Diabetes incidence in youth reported the burden of diabetes in youth <20 years of age in 2009 to be 191,986. Of these 166,984 had T1DM and 20,262 had T2DM(3). CDC diabetes statistics report card in 2014, reported 18,436 people younger than 20 years in United States were newly diagnosed with T1DM annually, and 5,089 people younger than 20 years were newly diagnosed with T2DM annually(4). Compared with other ethnic groups, non-Hispanic white children and adolescents had the highest rate of new cases of T1DM. While still uncommon, the rates of new cases of T2DM were greater among people aged 10–19 years than in younger children, with higher rates among U.S. Hispanic, African American and indigenous Indian minority populations(4). Diabetes mellitus is characterized by a high prevalence of atherosclerotic disease with 2-10 fold increased risk compared to the normal population (which is reported 20 times higher at least in T2DM). The process of atherosclerosis is known to begin in childhood (5, 6). Vascular dysfunction occurs early in the atherosclerotic process and this can be measured noninvasively by several measures of arterial stiffness such as Pulse wave analysis (PWA), pulse wave velocity (PWV) and brachial artery reactivity testing (BART)(5, 7). Emerging data suggest that subclinical vascular changes including increased arterial stiffness is present in youth with T1DM and T2DM well before signs of vascular disease are present(8). Arterial stiffness is a useful parameter to study because worsening arterial stiffness predicts early cardiovascular disease and may serve as a useful indicator of youth which are in need for intervention in the form of: 1. intensive insulin regimen 2. Hypertensive and dyslipidemia management 3. lifestyle modification like diet and exercise to prevent future adverse vascular outcomes(8, 9). Endocrine disrupting chemicals (EDC) are defined “an exogenous chemical, or mixture of chemicals, that interferes with any aspect of hormone action (10) Although there may be hundreds or more environmental chemicals with EDC activity, several classes like Bisphenol A and phthalates are most commonly studied(10).