Background: Diabetes is associated with increased risk of vascular disease. In children and adolescents with type 1 diabetes (T1D), clinical manifestations of vascular complications are infrequent; however, a pro-inflammatory state and endothelial disturbance could appear early. A subclinical inflammation state result in increased plasma levels of adhesion molecules, inflammatory cytokines as tumor necrosis factor alpha (TNFα), and acute phase proteins as C-reactive protein (CRP) and fibrinogen (Fg).
Objective and hypotheses: The objective of this work was study plasma levels of soluble E-selectin (sE-S), VCAM1, TNFα, high sensitivity CRP (hsCRP) and Fg in a pediatric population with T1D, without clinical evidence of vascular complications; and the relationship with glycemic control and disease evolution.
Method: Forty-two T1D patients and 20 control children, age 813 years, were studied. Biochemical parameters evaluated were: white blood cell count (WBC), sE-S and VCAM1, TNFα, hsCPR, and plasma Fg. Retinopathy and nephropathy was discarded cart by ophthalmic exam and microalbuminuria determination respectively.
Results: In diabetic patients compared with the control group found increased levels of sE-S (108 (69150) vs 68 (5286) ng/ml, P=0.003), VCAM1 (785 (732835) vs 712 (658758) ng/ml, P=0.04), and hsPCR (1.00 (0.671.70) vs 0.20 (0.180.87) mg/l, P=0.01). No significant differences on WBC, TNFα, or Fg values between diabetics and controls were found. When diabetic patients were grouped according glycemic control degree (A1c <8 and ≥8%) and disease evolution (≤3 and >3 years), no differences were found in the studied molecules. hsCPR correlated with glucose (r=0.54, P=0.001), A1c (r=0.41, P=0.01), sE-S (r=0.47, P=0.004), and VCAM1 (r=0.41, P=0.02).
Conclusion: The increased levels of hsPCR and adhesion molecules suggest that a proinflammatory state associated with endothelial activation are present in children with T1D, enhancing the risk of cardiovascular disease.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology