Background: Endothelial dysfunction is a macrovascular complication of type 1 diabetes. Children and adolescents with type 1 diabetes may suffer of endothelial dysfunction, irrespective of chronological age and disease duration.
Objective and hypotheses: After evaluating the prevalence of early endothelial dysfunction, as measured by mean of reactive hyperaemia in adolescents with type 1 diabetes, at baseline and after 1-year follow-up, we started a 6-month, double-blind, randomized trial to test the efficacy of an anti-oxidant diet (±α-lipoic acid supplementation) to improve endothelial dysfunction.
Method: Sixty-one children and adolescents, ages 16±3.5 years, with type 1 diabetes since 8.9±4.3 years, using inensified insulin therapy, were randomized into three arms: i) anti-oxidant diet 10 000 ORAC+α-lipoic acid; ii) anti-oxidant diet 10 000ORAC+placebo; iii) controls. BMI, blood pressure, fasting lipid profile, HbA1c, insulin requirement, dietary habits, and body composition were determined in each child.
Results: After 3 months BMI, blood pressure, lipid profiles, HbA1c, and body composition did not change, while insulin requirement significantly decreased only in patients in arm with anti-oxidant diet and α-lipoic acid (0.74±0.18 vs 0.83±0.26 U/kg/day, P<0.05), as well as bolus insulin (22.0±9.4 vs 26.3±10.8 U/day, P<0.05), but not basal insulin (25.9±9.4 vs 25.5±8.6 U/day, PNS). After 6 months same data were observed regarding insulin requirement with lower doses only in patients using supplementation. A significant improvement of endothelial function was observed in the two groups using the anti-oxidant diet, but not in controls. In group treated with α-lipoic acid a further slighter improvement was observed.
Conclusion: Adolescent with type 1 diabetes displayed evidence of endothelial improvement after α-lipoic acid and anti-oxidant diet, but not in controls. Moreover, to our knowledge these data demonstrate for the first time an of α-lipoic acid in sparing insulin requirement in young patients with type 1 diabetes.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology