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01.02.2015 | original article | Ausgabe 3-4/2015

Wiener klinische Wochenschrift 3-4/2015

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

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 3-4/2015
Autoren:
MD Georgiana-Aura Giurgea, MD Katrin Nagl, MD Michael Gschwandtner, MD Clemens Höbaus, MD Thomas Hörtenhuber, MD Renate Koppensteiner, MD Christian Margeta, MD Maria Fritsch, MD Birgit Rami-Merhar, MD Gerit-Holger Schernthaner, MD Oliver Schlager, MD Edith Schober, MD Sabine Steiner, MD Andrea Willfort-Ehringer

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.

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