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Cardiovascular Risk in Children and Adolescents with Type 2 Diabetes Mellitus

  • Pediatric Type 2 Diabetes (PS Zeitler, Section Editor)
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Abstract

The epidemic of childhood obesity worldwide has led to increased incidence of the metabolic syndrome and type 2 diabetes in the pediatric and adolescent population. As such, there is increasing concern that this large population of children is at risk for the long-term complications of diabetes, specifically cardiovascular disease. With cardiovascular disease remaining the leading cause of death in adults, this presents a significant public health concern as these children age. In this article, we discuss cardiovascular disease and risk in children and adolescents with type 2 diabetes, including the epidemiology of type 2 diabetes, atherosclerotic cardiovascular disease, obesity, hypertension, and left ventricular function.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146:693.

    Article  PubMed  Google Scholar 

  2. Pinhas-Hamiel O, Dolan LM, Daniels SR, et al. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr. 1996;128:608.

    Article  CAS  PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention. National Diabetes Fact Sheet. National Estimates and General Information of Diabetes and Prediabetes in the United States, 2011. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  4. Lee JM. Why young adults hold the key to assessing the obesity epidemic in children. Arch Pediatr Adolesc Med. 2008;162:682.

    Article  PubMed  Google Scholar 

  5. Lee JM, Okumura MJ, Freed GL, et al. Trends in hospitalizations for diabetes among children and young adults: United States, 1993-2004. Diabetes Care. 2007;30:3035.

    Article  PubMed  Google Scholar 

  6. Scott CR, Smith JM, Cradock MM, Pihoker C. Characteristics of youth-onset noninsulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus at diagnosis. Pediatrics. 1997;100:84.

    Article  CAS  PubMed  Google Scholar 

  7. Freedman DS, Srinivasan SR, Burke GL, et al. Relation of body fat distribution to hyperinsulinemia in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 1987;46:403.

    CAS  PubMed  Google Scholar 

  8. Caprio S, Hyman LD, Limb C, et al. Central adiposity and its metabolic correlates in obese adolescent girls. Am J Physiol. 1995;269:E118.

    CAS  PubMed  Google Scholar 

  9. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365:1876–85.

    Article  CAS  PubMed  Google Scholar 

  10. Tirosh A, Shai I, Afek A, Dubnov-Raz G, Ayalon N, Gordon B, et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med. 2011;364:1315–25.

    Article  CAS  PubMed  Google Scholar 

  11. Li L, Pinot de Moira A, Power C. Predicting cardiovascular disease risk factors in mid-adulthood from childhood body mass index: utility of different cutoffs for childhood body mass index. Am J Clin Nutr. 2011;93:1204–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136:664.

    Article  CAS  PubMed  Google Scholar 

  13. Kim C, McHugh C, Kwok Y, Smith A. Type 2 diabetes mellitus in Navajo adolescents. West J Med. 1999;170:210.

    CAS  PubMed Central  PubMed  Google Scholar 

  14. Savage PJ, Bennett PH, Senter RG, Miller M. High prevalence of diabetes in young Pima Indians: evidence of phenotypic variation in a genetically isolated population. Diabetes. 1979;28:937.

    Article  CAS  PubMed  Google Scholar 

  15. Arslanian S, Suprasongsin C. Differences in the in vivo insulin secretion and sensitivity of healthy black versus white adolescents. J Pediatr. 1996;129:440.

    Article  CAS  PubMed  Google Scholar 

  16. Arslanian SA. Metabolic differences between Caucasian and African-American children and the relationship to type 2 diabetes mellitus. J Pediatr Endocrinol Metab. 2002;15 Suppl 1:509.

    PubMed  Google Scholar 

  17. Danadian K, Balasekaran G, Lewy V, et al. Insulin sensitivity in African-American children with and without family history of type 2 diabetes. Diabetes Care. 1999;22:1325.

    Article  CAS  PubMed  Google Scholar 

  18. Svec F, Nastasi K, Hilton C, et al. Black-white contrasts in insulin levels during pubertal development. The Bogalusa Heart Study. Diabetes. 1992;41:313.

    Article  CAS  PubMed  Google Scholar 

  19. Banerji MA. Impaired beta-cell and alpha-cell function in African-American children with type 2 diabetes mellitus — "Flatbush diabetes". J Pediatr Endocrinol Metab. 2002;15 Suppl 1:493.

    CAS  PubMed  Google Scholar 

  20. Cruz ML, Weigensberg MJ, Huang TT, et al. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004;89:108.

    Article  CAS  PubMed  Google Scholar 

  21. Goran MI, Bergman RN, Avila Q, et al. Impaired glucose tolerance and reduced beta-cell function in overweight Latino children with a positive family history for type 2 diabetes. J Clin Endocrinol Metab. 2004;89:207.

    Article  CAS  PubMed  Google Scholar 

  22. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000;23:381.

    Article  Google Scholar 

  23. Copeland KC, Zeitler P, Geffner M, et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab. 2011;96:159.

    Article  CAS  PubMed  Google Scholar 

  24. Tattersal RB, Fajans SS. Prevalence of diabetes and glucose intolerance in 199 offspring of 37 conjugal diabetic parents. Diabetes. 1975;24:452.

    Article  CAS  PubMed  Google Scholar 

  25. Vassy JL, Dasmahapatra P, Meigs JB, Schork NJ, Magnussen CG, Chen W, et al. Genotype prediction of adult type 2 diabetes from adolescence in a multi-racial population. Pediatrics. 2012;130:e1235–42.

    Article  PubMed  Google Scholar 

  26. Vassy JL, Donelan K, Hivert MF, Green RC, Grant RW. Genetic susceptibility testing for chronic disease and intention for behavior change in healthy young adults. J Community Genet. 2013;4:263–71.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Ryo M et al. Adiponectin as a biomarker of the metabolic syndrome. Circ J. 2004;68:975–81.

    Article  CAS  PubMed  Google Scholar 

  28. Ouchi N, Kihara S, Funahashi T, Matsuzawa Y, Walsh K. Obesity, adiponectin and vascular inflammatory disease. Curr Opin Lipidol. 2003;14:561–6.

    Article  CAS  PubMed  Google Scholar 

  29. Li S, Shin HJ, Ding EL, van Dam RM. Adiponectin levels and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2009;302:179–88.

    Article  CAS  PubMed  Google Scholar 

  30. Siitonen N, Pulkkinen L, Lindström J, Kolehmainen M, Schwab U, Eriksson JG, et al. Association of ADIPOR2 gene variants with cardiovascular disease and type 2 diabetes risk in individuals with impaired glucose tolerance: the Finnish Diabetes Prevention Study. Cardiovasc Diabetol. 2011;10:83. doi:10.1186/1475-2840-10-83.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Moss SE, Klein R, Klein BE. Cause-specific mortality in a population-based study of diabetes. Am J Public Health. 1991;81:1158–62.

    Article  CAS  PubMed  Google Scholar 

  32. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434–44.

    Article  CAS  PubMed  Google Scholar 

  33. Laakso M. Diabetes and cardiovascular disease in type 2 diabetes: challenge for treatment and prevention. J Intern Med. 2001;249:225–35.

    Article  CAS  PubMed  Google Scholar 

  34. Juutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective population-based study in Finnish subjects. Diabetes Care. 2005;28:2901–7.

    Article  PubMed  Google Scholar 

  35. Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman III WP, Herderick EE, et al. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA. 1999;281:727–35.

    Article  CAS  PubMed  Google Scholar 

  36. Berenson GS, Srinivasan SR, Bao W, Newman III WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338:1650–6.

    Article  CAS  PubMed  Google Scholar 

  37. Zieske AW, Malcom GT, Strong JP. Natural history and risk factors of atherosclerosis in children and youth: the PDAY study. Pediatr Pathol Mol Med. 2002;21:213–37.

    Article  PubMed  Google Scholar 

  38. Tracy RE, Newman III WP, Wattigney WA, Berenson GS. Risk factors and atherosclerosis in youth autopsy findings of the Bogalusa Heart Study. Am J Med Sci. 1995;310:37–41.

    Article  Google Scholar 

  39. Magge SN. Cardiovascular risk in children and adolescents with type 1 and type 2 diabetes mellitus. Curr Cardiovasc Risk Rep. 2012;6:591–600.

    Article  PubMed Central  PubMed  Google Scholar 

  40. McGill Jr HC, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE, et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation. 2002;105:2712–8.

    Article  PubMed  Google Scholar 

  41. Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, et al. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol. 1996;27:277–84.

    Article  CAS  PubMed  Google Scholar 

  42. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003;290:2277–83.

    Article  CAS  PubMed  Google Scholar 

  43. Schmidt AM, Yan SD, Wautier JL, Stern D. Activation of receptor for advanced glycation end products: a mechanism for chronic vascular dysfunction in diabetic vasculopathy and atherosclerosis. Circ Res. 1999;84:489–97.

    Article  CAS  PubMed  Google Scholar 

  44. Libby P, Plutzky J. Diabetic macrovascular disease: the glucose paradox? Circulation. 2002;106:2760–3.

    Article  PubMed  Google Scholar 

  45. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  46. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643–53.

    Article  PubMed  Google Scholar 

  47. Nathan DM, Lachin J, Cleary P, Orchard T, Brillon DJ, Backlund JY, et al. Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl J Med. 2003;348:2294–303.

    Article  PubMed  Google Scholar 

  48. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  49. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. Ten-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–89.

    Article  CAS  PubMed  Google Scholar 

  50. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405–12.

    Article  CAS  PubMed  Google Scholar 

  51. Friedman GD, Cutter GR, Donahue RP, et al. CARDIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol. 1988;41:1105–16.

    Article  CAS  PubMed  Google Scholar 

  52. Loria CM, Liu K, Lewis CE, Hulley SB, Sidney S, Schreiner PJ, et al. Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study. J Am Coll Cardiol. 2007;49:2013–20.

    Article  PubMed  Google Scholar 

  53. Schauer IE, Snell-Bergeon JK, Bergman BC, Maahs DM, Kretowski A, Eckel RH, et al. Insulin resistance, defective insulin-mediated fatty acid suppression, and coronary artery calcification in subjects with and without type 1 diabetes: the CACTI study. Diabetes. 2011;60:306–14.

    Article  CAS  PubMed  Google Scholar 

  54. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997;146:483–94.

    Article  CAS  PubMed  Google Scholar 

  55. Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, et al. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128:262–9.

    Article  CAS  PubMed  Google Scholar 

  56. Furberg CD, Adams Jr HP, Applegate WB, Byington RP, Espeland MA, Hartwell T, et al. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group. Effect of lovastatin on early carotid atherosclerosis and cardio- vascular events. Circulation. 1994;90:1679–87.

    Article  CAS  PubMed  Google Scholar 

  57. Pitt B, Byington RP, Furberg CD, Hunninghake DB, Mancini GB, Miller ME, et al. Prevent Investigators. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation. 2000;102:1503–10.

    Article  CAS  PubMed  Google Scholar 

  58. Salonen R, Nyyssonen K, Porkkala E, Rummukainen J, Belder R, Park JS, et al. Kuopio Atherosclerosis Prevention Study (KAPS): a population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and femoral arteries. Circulation. 1995;92:1758–64.

    Article  CAS  PubMed  Google Scholar 

  59. Urbina EM, Gao Z, Khoury PR, Martin LJ, Dolan LM. Insulin resistance and arterial stiffness in healthy adolescents and young adults. Diabetologia. 2012;55:625–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Wadwa RP, Urbina EM, Anderson AM, Hamman RF, Dolan LM, Rodriguez BL, et al. SEARCH Study Group. Measures of arterial stiffness in youth with type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2010;33:881–6.

    Article  PubMed  Google Scholar 

  61. Shah AS, Khoury PR, Dolan LM, Ippisch HM, Urbina EM, Daniels SR, et al. The effects of obesity and type 2 diabetes mellitus on cardiac structure and function in adolescents and young adults. Diabetologia. 2011;54:722–30.

    Article  CAS  PubMed  Google Scholar 

  62. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6.

    Article  CAS  PubMed  Google Scholar 

  63. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991;114:345–52.

    Article  CAS  PubMed  Google Scholar 

  64. Li X, Li S, Ulusoy E, Chen W, Srinivasan SR, Berenson GS. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study. Circulation. 2004;110:3488–92.

    Article  PubMed  Google Scholar 

  65. Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation. 1995;91:2400–6.

    Article  CAS  PubMed  Google Scholar 

  66. Nadeau KJ, Regensteiner JG, Bauer TA, Brown MS, Dorosz JL, Hull A, et al. Insulin resistance in adolescents with type 1 diabetes and its relationship to cardiovascular function. J Clin Endocrinol Metab. 2010;95:513–21.

    Article  CAS  PubMed  Google Scholar 

  67. Matikainen N, Taskinen MR. Management of dyslipidemias in the presence of the metabolic syndrome or type 2 diabetes. Curr Cardiol Rep. 2012;14:721–31.

    Article  PubMed  Google Scholar 

  68. Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, Shaw M, et al. The triglyceride-to-HDL cholesterol ratio: association with insulin resistance in obese youths of different ethnic backgrounds. Diabetes Care. 2011;34:1869–74.

    Article  PubMed  Google Scholar 

  69. Weiss R, Otvos JD, Sinnreich R, Miserez AR, Kark JD. The triglyceride to high-density lipoprotein-cholesterol ratio in adolescence and subsequent weight gain predict nuclear magnetic resonance-measured lipoprotein subclasses in adulthood. J Pediatr. 2011;158:44–50.

    Article  CAS  PubMed  Google Scholar 

  70. Burns SF, Lee SJ, Arslanian SA. Surrogate lipid markers for small dense low-density lipoprotein particles in overweight youth. J Pediatr. 2012;161(6):991–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  71. TODAY Study Group. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366:2247–56.

    Article  PubMed Central  Google Scholar 

  72. TODAY Study Group. Lipid and inflammatory cardiovascular risk worsens over 3 years in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care. 2013;36:1758–64. This study demonstrates that adolescents with T2DM have a high prevalence of dyslipidemia and describes the difficulty in achieving lipid goals in this population. It also shows that diabetes interventions do not appear to prevent the worsening of CVD risk.

    Article  Google Scholar 

  73. Li C, Ford ES, McBride PE, Kwiterovich PO, McCrindle BW, Gidding SS. Non-high-density lipoprotein cholesterol concentration is associated with the metabolic syndrome among US youth aged 12-19 years. J Pediatr. 2011;158:201–7.

    Article  CAS  PubMed  Google Scholar 

  74. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. summary report. Pediatrics. 2011;128:S213. These guidelines are the first to recognize T2DM as a condition associated with accelerated atherosclerosis and early CVD.

    Article  Google Scholar 

  75. Hypertension in Diabetes Study (HDS). I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens. 1993;11:309–17.

    Article  Google Scholar 

  76. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension. 1992;19:403.

    Article  CAS  PubMed  Google Scholar 

  77. Randeree HA, Omar MA, Motala AA, Seedat MA. Effect of insulin therapy on blood pressure in NIDDM patients with secondary failure. Diabetes Care. 1992;15:1258.

    Article  CAS  PubMed  Google Scholar 

  78. Nosadini R, Sambataro M, Thomaseth K, et al. Role of hyperglycemia and insulin resistance in determining sodium retention in non-insulin-dependent diabetes. Kidney Int. 1993;44:139.

    Article  CAS  PubMed  Google Scholar 

  79. Cruickshank K, Riste L, Anderson SG, et al. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106:2085.

    Article  PubMed  Google Scholar 

  80. de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. 2011;305:2532–9.

    Article  PubMed Central  PubMed  Google Scholar 

  81. de Galan BE, Perkovic V, Ninomiya T, Pillai A, Patel A, Cass A, et al. Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol. 2009;20:883–92.

    Article  PubMed  Google Scholar 

  82. Shatat IF, Flynn JT. Relationships between renin, aldosterone, and 24-hour ambulatory blood pressure in obese adolescents. Pediatr Res. 2011;69:336–40.

    Article  CAS  PubMed  Google Scholar 

  83. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. UKPDS Study Group. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes. 2006;55:1832–9.

    Article  CAS  PubMed  Google Scholar 

  84. Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet. 2007;369:1823–31.

    Article  PubMed  Google Scholar 

  85. Today Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care. 2013;36:1735–41. This study provides a thorough description of the prevalence and natural history of hypertension and microalbuminuria in adolescents with T2DM.

    Article  Google Scholar 

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Christopher Prendergast declares that he has no conflict of interest. Samuel S. Gidding declares that he has no conflict of interest.

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  1. A. I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Christopher Prendergast & Samuel S. Gidding

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  1. Christopher Prendergast
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This article is part of the Topical Collection on Pediatric Type 2 Diabetes

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Prendergast, C., Gidding, S.S. Cardiovascular Risk in Children and Adolescents with Type 2 Diabetes Mellitus. Curr Diab Rep 14, 454 (2014). https://doi.org/10.1007/s11892-013-0454-0

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