ESPE Abstracts

Background: Nail-fold capillaroscopy (NFC), a non-invasive tool that can detect microvascular changes, has recently gained popularity in the diabetes field as a warning sign before the development of diabetes-related complications.

Objective: We aimed to assess capillary microarchitecture in children with type 1 diabetes mellitus (T1DM) by comparing them with a healthy control group.

Subjects and Methods: The study included 55 children aged between 6-18 years with T1DM for at least a year and 55 age-matched healthy controls without diabetes. We collected data on diabetes duration, average HbA1c values over the past year for all patients, and data from the preceding 3 months for patients using 24-hour continuous glucose monitoring (CGM) devices. The capillaroscopic findings were evaluated by two different researchers with experience in the field of pediatric rheumatology. Capillaroscopic parameters were compared in patients with diabetes based on glycemic control (HbA1c ≥7.5%, poor control; <7.5%, good control) and disease duration (<5 years vs. ≥5 years). For patients who used CGM [n = 22, median duration of diabetes 3.1 (1.7–5.7) years], the capillaroscopic findings were also compared based on their time in range (≥70% vs. <70%) and glucose variability (≤36% vs. >36%).

Results: The median age of patients with T1DM was 14.5 (11.3–17.2) years, with a median disease duration of 3.8 (2.3–6.7) years. Patients with diabetes showed a significantly lower capillary density and a higher prevalence of dilated, tortuous, cross-linked, and abnormal morphological capillaries than healthy individuals (P <0.001). Patients with poor glycemic control exhibited significantly lower capillary density than those with good glycemic control (P <0.001). After adjusting for age, gender, BMI, and diabetes duration, a negative correlation between capillary density and average HbA1c was observed (r = -0.4, P =0.004). Among patients with T1DM, those with a disease duration of ≥5 years had significantly reduced capillary density compared to those with a duration of <5 years (P =0.02). Additionally, capillary density negatively correlated with disease duration (r = -0.3, P =0.02). Capillaroscopic findings were similar based on the time in range and glucose variability of patients using CGM.

Conclusion: Patients with T1DM exhibited significantly higher microvascular changes, mostly associated with poor glycemic control, compared to healthy controls. NFC can be a useful technique for detecting early alterations in the capillary structures of children with T1DM, even in the absence of microvascular complications.