Magnetic resonance imaging measures of decreased aortic strain and distensibility are proportionate to insulin resistance in adolescents with type 1 diabetes mellitus

Objectives To determine whether children with type 1 diabetes mellitus ( T1DM ) have evidence of increased aortic stiffness or early atherosclerosis as measured by magnetic resonance imaging ( MRI ). Background T1DM increases risk for cardiovascular disease in adults but whether this process starts in childhood is unknown. Subjects A total of 54 T1DM patients (15.4 ± 2.6 yr) and 30 age‐matched controls (14.8 ± 2.7 yr) participated. Methods MRI was performed to assess aortic arch pulse wave velocity ( PWV ), strain, and distensibility of the ascending and descending thoracic aorta and measures of atherosclerosis. Results Groups were well‐matched for age, pulse pressure, and gender. Low‐density lipoprotein‐cholesterol ( LDL ‐C) was higher in T1DM (119.3 ± 50 vs. 76.1 ± 13.5 mg/dL, p < 0.0001). There was a trend toward decreased strain and distensibility in T1DM vs. controls in the ascending (distensibility: T1DM 62.2 ± 19.9 kPa −1 × 10 −3 , control 71.6 ± 26.4 kPa −1 × 10 −3 , p = 0.08) and descending aorta (strain: T1DM 25.8 ± 6.2% vs. control 28.3 ± 6.8%, p = 0.09). There was no difference in arch PWV . Advancing age and male gender was negatively associated with aortic stiffness. Hemoglobin A1c ( HbA1c ) was inversely related to descending aorta strain and distensibility (p < 0.05). Children with diabetes in the lowest two tertiles of insulin sensitivity demonstrated thoracic descending aortas with significantly lower strain (p = 0.027) and distensibility (p = 0.039) and increased measures of wall irregularity (p = 0.005). There were no differences in measurements of atherosclerosis between the two groups. Conclusions Adolescents with T1DM , especially those with lower insulin sensitivity, demonstrated a trend toward stiffer, less compliant thoracic aortas, which was inversely associated with diabetes control. These data suggest large vessel aortopathy starts early in T1DM .