Introduction: Patients with type 1 diabetes (T1D) are at high risk of developing vascular complications. Endothelial dysfunction is considered the early reversible stage in the development of diabetes related vascular disease. Early detection and management of endothelial dysfunction can delay or even prevent the development of vascular complications.
Aim: Endothelial dysfunction is associated with poor metabolic control in adolescents with T1D. Based on this hypothesis we aimed to determine the relationship between metabolic control and endothelial function in a cohort of adolescents with T1D. We postulated that by Identifying those at increased risk of cardiovascular disease, we could introduce targeted intervention to reduce the occurrence of cardiovascular complications.
Methods: 42 adolescents with T1D attending the Paediatric Diabetes and Endocrinology service at Tallaght Hospital, Dublin were recruited. Candidates attended for assessment following an overnight fast, auxiology and BMI were calculated. Blood pressure was measured in the supine position followed by assessment of the Reactive hyperaemia index (RHI) by Endo-PAT. Blood samples were taken for evaluation of HbA1c, liver, renal function, lipid status and celiac screen. Serum of 20 candidates was reserved for measurement of inflammatory markers (adiponectin, leptin, thrombomodulin, serum intravascular adhesion molecules, E-Selectin and P-Selectin). First morning urine sample was provided for estimation of microalbumin to creatinine ratio. Participants completed a physical activity questionnaire. Baseline data included the date of diagnosis, duration of diabetes, current insulin dose; insulin regimen; daily screen time; and relevant Family history of early cardiovascular disease.
Results: Reactive hyperaemia index correlated with age. Thirteen adolescents (31%) had low RHI, suggesting relatively impaired endothelial function. lower RHI correlated with higher diastolic blood pressure (r=−0.34) and P-Selectin level (r=−0.3) suggesting impairment in vascular health. Poor metabolic control was associated with impaired lipid profile (r=0.55), higher diastolic blood pressure (r=0.38) and higher level of inflammatory markers P- selectin (r=0.55), thrombomodulin (r=0.31) and adiponectin (r=0.33). E-Selectin, P-Selectin and thrombomodulin were associated with lower HDL (r=−0.34, −0.38, −0.38). Elevated ACR with E-Selectin (r=0.32) and systolic blood pressure with thrombomodulin (r=0.36). Active life style was associated with improved blood pressure (r=−0.35) and lipid profile (r=−0.39).
Conclusion: Reactive artery tonometry is an easy, non-invasive reliable method of assessing endothelial function. Impaired endothelial function correlated with elevated diastolic blood pressure and elevated P-selectin level. Maintaining a healthy life style improves the general health and in particular vascular health of those with T1D and should be actively encouraged.
27 Sep 2018 - 29 Sep 2018