Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with diabetes. Macro- and micro-vascular complications are involved in the pathophysiology of CVD and the increased risk of developing atherosclerosis in this population. A probable association between type 1 diabetes (Type 1 D) and CVD has been attributed to chronic uncontrolled hyperglycemia, inflammation, endothelial dysfunction (ED), and subclinical manifestations of vascular disease. This study aimed at assessing the endothelial function in children and adolescents with Type 1 diabetes (T1DM) using flow-mediated dilatation (FMD) response and carotid artery intima-media thickness (cIMT) as indices of presence of subclinical atherosclerosis. A cross sectional study included 100 children and adolescents with T1D with age range from 5 to 15 years and disease duration more than 5 years, following in Diabetes Unit, Children's Hospital, Cairo University. Fifty age and sex matched controls were also included. Patients on any medications other than insulin, especially antihypertensive, antiplatelet or lipid lowering medications were excluded. Also Patients with anemia, family history of hypercholesterolemia or premature cardiovascular disease were excluded. Glycated hemoglobin, urinary albumin/creatinine ratio, and fasting lipid profile were studied. FMD and cIMT were assessed with high-resolution ultrasound using standardized measurements.
This results showed that FMD was significantly lower in patients in the T1D Group (2.9 ± 1.9%) compared with controls (8.5 ± 1.1%; P-value < 0.001). Similarly, cIMT differed significantly between T1D patients (0.48 ± 0.06 mm) and controls (0.46 ± 0.07 mm; P-value = 0.02). There was significant positive correlation between cIMT and duration of diabetes (r=0.6, P<0.001), age of onset of diabetes (r = 0.3, P=0.001), mean HA1C (r=0.6, P <0.001), LDL cholesterol (r=0.6, P <0.001) and significant negative correlation with HDL cholesterol levels (r=-0.6, P < 0.001).
On the other hand, there was significant negative correlation between FMD% and duration of diabetes (r= -0.2, P=0.004), total insulin dose (r= -0.2, P= 0.01), mean HA1C (r= -0.37 P<0.001, total cholesterol (r=- 0.2, P = 0.009), LDL cholesterol (r= - 0.3, P=0.002), serum Triglycerides (r= -0.4, P=0.001) and significant positive correlation with HDL cholesterol (r =0.3, P= 0.001).
Diabetic patients had statistically significant higher cIMT and lower FMD than normal healthy controls which reflects the significant presence of higher risk of endothelial dysfunction, premature atherosclerosis and peripheral vascular disease in this type of population. The role of T1D in atherosclerosis is still poorly understood and further large-scale studies are still needed.
19 Sep 2019 - 21 Sep 2019