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Gender, metabolic control and carotid intima-media-thickness in children and adolescents with type 1 diabetes mellitus

Geschlecht, metabolische Kontrolle und Carotis Intima-Media-Dicke bei Kindern und Jugendlichen mit Type 1 Diabetes mellitus

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Summary

Background

Despite a marked improvement in the overall prognosis of patients with type 1 diabetes mellitus (T1DM), cardiovascular morbidity/mortality is still increased. Since cellular and microvascular aberrations have been demonstrated already in children with T1DM, albeit a good glycemic control (CO), we hypothesized that early macrovascular changes can be detected by common carotid artery intima-media thickness (CCA-IMT).

Methods

We included 73 children/adolescents with T1DM (34 boys, 39 girls; mean age, 14.8 ± 2 years) and 243 sex- and age-matched healthy CO. In T1DM mean HbA1c was 7.9 ± 1.1 rel.%, and duration of disease 7.5 ± 3.1 years. High-resolution ultrasonography was used to assess CCA-IMT, defined as the mean of 24 measurements of the near and far wall on both right and left CCA.

Results

CCA-IMT was not different in the total of children and adolescents with T1DM compared with CO (0.302 ± 0.057 vs. 0.301 ± 0.054 mm; p = 0.88). Analysis according to gender, however, revealed higher CCA-IMT values in girls than in boys in the diabetic cohort (0.315 ± 0.055 vs. 0.288 ± 0.058 mm; p = 0.047), whereas CCA-IMT was higher in boys than in girls in the CO group (0.321 ± 0.057 vs. 0.284 ± 0.045 mm; p < 0.001). Multiple stepwise backward regression showed that in the T1DM group only HbA1c remained significantly associated with CCA-IMT (Beta = − 0.307, p = 0.008). In CO, gender (Beta = − 0.302, p < 0.001), body mass index (Beta = 0.226, p < 0.001) and systolic blood pressure (Beta = 0.213, p < 0.001) were predictive of CCA-IMT.

Conclusion

Our data suggest that in children/adolescents with T1DM the quality of metabolic CO (HbA1c) is the most important predictor of CCA-IMT and outweighs the effect of gender.

Zusammenfassung

Hintergrund

Trotz der besseren Allgemeinprognose von Patienten mit Diabetes Mellitus Typ 1 (T1DM) ist die kardiovaskuläre Morbidität/Mortalität noch hoch. Da bereits über zelluläre und mikrovaskuläre Veränderungen bei Kindern und Jugendlichen mit T1DM auch im Fall einer guten glykämischen Kontrolle berichtet wurde, haben wir angenommen, dass sehr frühe makrovaskuläre Veränderungen durch die Messung der Intima-Media-Dicke im Bereich der Arteria carotis communis (CCA-IMT) detektiert werden könnten.

Methoden

Eingeschlossen wurden 73 Kinder und Jugendliche mit T1DM (34 männlich, 39 weiblich; Durchschnittsalter 14,8 ± 2 Jahre) und 243 geschlechts- und altersgematchte gesunde Kontrollen (CO). Bei T1DM betrug der HbA1c-Mittelwert 7,9 ± 1,1 rel. % und die Krankheitsdauer 7,5 ± 3,1 Jahre. Die CCA-IMT wurde mittels Duplexsonographie ermittelt und als Mittelwert aus 24 Messungen im Bereich der anterioren und posterioren Wand der rechten und linken ACC definiert.

Ergebnisse

Wir fanden keinen signifikanten Unterschied in der CCA-IMT zwischen T1DM und CO Gruppe (0,302 ± 0,057 vs. 0,301 ± 0,054 mm; p = 0,88). In der geschlechtsbezogenen Subgruppenanalyse zeigte sich jedoch ein statistisch signifikanter Unterschied zwischen weiblichem und männlichem Kollektiv mit höheren IMT-Werten für Mädchen (0,315 ± 0,055 vs. 0,288 ± 0,058 mm; p = 0,047) in der T1DM Gruppe und höheren Werten für Jungen in der CO-Gruppe (0,321 ± 0,057 vs. 0,284 ± 0,045 mm; p < 0,001).

Nach multiplen rückwärts Regressionsanalysen zeigte in der T1DM Gruppe nur noch der HbA1c-Wert eine signifikante Assoziierung mit CCA-IMT (Beta = − 0,307, p = 0,008). In der CO Gruppe waren Geschlecht (Beta = − 0,302, p < 0,001), BMI (Beta = 0,226, p < 0,001) und systolischer Blutdruck (Beta = 0,213, p < 0,001) prädiktiv für CCA-IMT.

Schlussfolgerung

Unsere Ergebnisse suggerieren, dass in Kindern/Jugendlichen mit T1DM die Qualität der metabolischen Kontrolle (HbA1c) der wichtigste Prädiktor für CCA-IMT ist und auch die geschlechtsbezogenen Unterschiede aufheben kann.

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Authors and Affiliations

  1. Department of Medicine II, Division of Angiology, Medical University & General Hospital Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Georgiana-Aura Giurgea MD, Michael Gschwandtner MD, Clemens Höbaus MD, Renate Koppensteiner MD, Christian Margeta MD, Gerit-Holger Schernthaner MD, Oliver Schlager MD, Sabine Steiner MD & Andrea Willfort-Ehringer MD

  2. Pediatrics and Adolescent Medicine, Medical University & General Hospital Vienna, Vienna, Austria

    Katrin Nagl MD, Thomas Hörtenhuber MD, Maria Fritsch MD, Birgit Rami-Merhar MD & Edith Schober MD

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  1. Georgiana-Aura Giurgea MD
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Correspondence to Georgiana-Aura Giurgea MD.

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Giurgea, GA., Nagl, K., Gschwandtner, M. et al. Gender, metabolic control and carotid intima-media-thickness in children and adolescents with type 1 diabetes mellitus. Wien Klin Wochenschr 127, 116–123 (2015). https://doi.org/10.1007/s00508-014-0640-3

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