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part of the follow-up visit protocol.  Measures include: 1) the Michigan 
Neuropathy Screening Instrument (MNSI); and 2) CAN assessment using 
electrocardiogram analyses.  Evaluation of the associations of peripheral 
neuropathy and CAN with measures of subclinical macrovascular disease and its 
risk factors in the SEARCH Cohort study will yield important information. 
4.2.1.2.
 
Risk Factors 
Glycemic Control.  Studies among children and youth with diabetes generally report 
a constellation of related socio-demographic factors that are associated with poor 
glycemic control, including race/ethnicity, socioeconomic status, lower parental 

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Section 4B - Study Objectives/Background and Significance (Phase 3 - 12/2010) 
Section 4B - Page 9 
 Cohort 
Study
 
 
educational attainment, parental involvement in diabetes management, and family 
dynamics 
(81 - 87)
.  Similar patterns were observed in SEARCH, both for T1 and T2D 
youth 
(11)
, and may be partly mediated by our observation of worse glycemic control 
among T1D youth on insulin regimens other than CSII 
(24)
.  In SEARCH, 17% of 
youth with T1D (n=3947) and 27% of T2D (n=552) respectively had poor glycemic 
control (HbA
1c
> 9.5%).  For both T1 and T2D, higher A1c was also associated with 
higher concentrations of apoB and LDL particle size 
(88)
, and elevated ACR 
(68)
, 
suggesting possible links early in the history of diabetes between glycemic control 
and future risk for both macro- and microvascular disease that require further study.