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Intima‐media thickness at different arterial segments in pediatric type 1 diabetes patients and its relationship with advanced glycation end products
Author(s) -
Lilje Christian,
Cronan Julie C,
Schwartzenburg Elridge J,
Owers Elizabeth M,
Clesi Patrice,
Gomez Ricardo,
Stender Sarah,
Hempe James,
Chalew Stuart A,
Cardinale Jeffrey P
Publication year - 2018
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12557
Subject(s) - medicine , type 1 diabetes , intima media thickness , cardiology , diabetes mellitus , population , pulse wave velocity , blood pressure , carotid arteries , endocrinology , environmental health
Background Patients with type 1 diabetes mellitus ( T1DM ) are at risk for premature atherosclerosis ( AS ), which has its origin in childhood. Carotid intima‐media thickness ( IMT ) is an established surrogate marker for subclinical AS in adults. The first macroscopically detectable AS changes, however, begin in the abdominal aorta. Advanced glycation end products ( AGE ) predict microvascular complications in diabetes. Objectives To assess the sensitivity for early macrovascular changes of brachial, femoral, and aortic IMT compared to conventional carotid IMT in pediatric T1DM patients ; and the relationship of IMT with AGE . Methods Using high‐resolution external ultrasound, carotid, brachial, femoral, and aortic IMT were prospectively analyzed in children and adolescents with established T1DM and in controls (Ctrls). AGE were estimated by skin intrinsic fluorescence ( SIF ). Other established cardiovascular risk factors were excluded. Results Seventy‐six subjects ( T1DM = 38; Ctrls = 38) with a mean age of 13.1 ± 4.0 years (6‐19, median 13) qualified for analysis. Carotid, brachial, femoral, and aortic IMT analyses were feasible in 100%, 74%, 84%, and 92% of subjects, respectively. Aortic and femoral IMT were increased in T1DM patients (0.60 ± 0.11 vs 0.52 ± 0.10 mm, P < .001; and 0.41 ± 0.07 vs 0.36 ± 0.07 mm, P < .01, respectively) while carotid and brachial IMT were not. AGE levels were elevated in T1DM patients and correlated with aortic IMT only. The influence of AGE on aIMT did not remain significant after adjusting for T1DM and age in our small population. Conclusion We found aortic IMT —and to a lesser degree femoral IMT —to be more sensitive than carotid and brachial IMT for detecting early macrovascular changes in pediatric T1DM patients.