ESPE Abstracts (2018) 89 RFC3.1

Diagnostics of Early Atherosclerosis Risk in Kids (DEAR-Kids): Retinal Vessel Analysis in Pediatric Type 1 Diabetes - Retinal Arteriolar Narrowing Caused By High HbA1c

Michael Wurma, Kühnemund Leoniea, Lisa Maiera, Xia Mia, Kai Lichteb, Kristiane Hallermanna, Alexandra Krausea, Corinna Brichtaa, Natascha van der Werf-Grohmanna, Andreas Krebsa, Henner Hanssenc, Peter Deibertd & Karl Otfried Schwaba


aDepartment of General Paediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany; bChildrens Hospital Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany; cDivision of Preventive Sports Medicine and Systems Physiology, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; dFaculty of Medicine, Institute for Exercise and Occupational Medicine, Medical Centre, University of Freiburg, Freiburg, Germany


Background/Objective: Micro-and macrovascular changes are the cause for diabetes complications. Retinal vessel analysis is a unique method to examine microvascular changes in brain derived vessels.

Subjects/Methods: Sixty-seven pediatric and adolescent type 1 diabetes patients and 58 healthy control persons underwent nonmydriatic retinal photography of both eyes. Arterioles and venules positioned in the region 0.5 to 1 diameter of the optic disc measured from its margin were identified and measured. Central retinal arteriolar and venular equivalents (CRAE/CRVE) and arteriovenolar ratio (AVR) were calculated. Data were analysed by students T-test. Multiple linear regression was used to determine factors influencing measurements of arteriolar and venular vessels. In multiple linear regression analysis, several models were used for adjustment. Model 1 included sex, age, body length, BMI, diabetes duration and average HbA1c of the recent year as covariates. Model 2 and 3 added systolic and diastolic blood pressure, respectively. Model 4 additionally comprised waist circumference and model 5 included current blood glucose as covariate.

Results: Patients did not differ in sex distribution, age, height, weight, BMI and BMI-SDS, total cholesterol, LDL and HDL. Diabetes patients had higher triglycerides (Mean 115 vs 87 mg/dl; P< 0.01), systolic blood pressure (117 vs 112 mmHg; P=0.023) and waist circumference (69.8 vs 66.4 cm; P=0.046) than control subjects. Diabetes patients did not differ in CRAE, CRVE and AVR compared to healthy controls overall. Per percent increase in HbA1c, CRAE was reduced by 4.3 μm (95%-CI 0.2–8.0 μm) up to 5.4 μm (95%-CI 8.2–2.6 μm), depending on model of adjustment. CRVE was not associated with diabetes duration or HbA1c.

Conclusion: Microvascular arteriolar changes caused by poor diabetes control are already present in childhood and may indicate early atherosclerosis and increased risk for diabetes complications. Multiple studies in adults show that retinal arteriolar narrowing is associated with diabetes sequela and cardiovascular disease in adulthood. Further investigation warranted this may lead to end organ damage based therapeutic goals in pediatric diabetes patients.