Abstract

Objective: Type 1 diabetes mellitus (T1DM) patients have an increased risk of developing cardiovascular disease. Our study aimed to compare epicardial fat thickness (EFT), carotid intima‐media thickness (cIMT), and arterial stiffness parameters such as pulse wave velocity (PWV), augmentation index (AI), which are well-known early markers of cardiovascular disease in adults, between children with T1DM and healthy individuals.

Methods: One hundred fifteen children with T1DM and 87 age, gender, and anthropometric measurements-matched healthy children were included. The inclusion criteria for patients were having T1DM for at least 2 years and ages 8–18 years. Epicardial fat thickness and cIMT were assessed by the same pediatric cardiologist. Noninvasively, the Mobil-O-Graph® was used to evaluate PWV, AI (normalized to a heart rate of 75 beats/sec: AI@75), and the hemodynamic parameters.

Results: Epicardial fat thickness and cIMT were higher (p<0.001), stroke volume and cardiac index scores were found significantly lower (p<0.001 and p=0.030, respectively) in the patient group compared with the control group. While the AI@75 was significantly higher in the patient group (p <0.01), PWV did not differ between groups (p=0.782). According to the glycated hemoglobin A1c (HbA1c) level, EFT (p=0.015) was significantly higher, and cardiac index score (p=0.030) was significantly lower in the HbA1c >9% group. A strong positive correlation was detected between mean cIMT and microalbuminuria (Rho=,925, p<0.01).

Conclusion: These results support that children with T1DM present significant changes in important subclinical indicators for showing the development of cardiovascular disease. Cardiologic assessment of patients with T1DM can be beneficial for long-term care. 

Keywords: arterial stiffness, carotid intima‐media thickness, epicardial fat thickness, type 1 diabetes mellitus

Copyright and license

How to cite

1.
Büyükyılmaz G, Özdemir Şahan Y, Tehçi AK, Özer E, Özdemiroğlu N, İnozü M, et al. Evaluation of cardiovascular disease risk in children with type 1 diabetes mellitus by oscillometric method and echocardiography. Trends in Pediatrics. 2024;5(4):116-123. https://doi.org/10.59213/TP.2024.167

References

  1. Sperling MA, Wolfsdorf JI, Menon RK, et al. Diabetes mellitus. In: Sperling Pediatric Endocrinology; 2021. p. 814–83. [Crossref]
  2. de Ferranti SD, de Boer IH, Fonseca V, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2014;37:2843-63. [Crossref]
  3. Marcovecchio ML, Dalton RN, Daneman D, et al. A new strategy for vascular complications in young people with type 1 diabetes mellitus. Nat Rev Endocrinol. 2019;15:429-35. [Crossref]
  4. Lind M, Svensson AM, Kosiborod M, et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014;371:1972-82. [Crossref]
  5. Strong JP, Malcom GT, McMahan CA, et al. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA. 1999;281:727-35. [Crossref]
  6. Lopes-Virella MF, Carter RE, Gilbert GE, et al. Risk factors related to inflammation and endothelial dysfunction in the DCCT/EDIC cohort and their relationship with nephropathy and macrovascular complications. Diabetes Care. 2008;31:2006-12. [Crossref]
  7. Schram MT, Chaturvedi N, Schalkwijk C, et al. Vascular risk factors and markers of endothelial function as determinants of inflammatory markers in type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetes Care. 2003;26:2165-73. [Crossref]
  8. Schnell O, Cappuccio F, Genovese S, Standl E, Valensi P, Ceriello A. Type 1 diabetes and cardiovascular disease. Cardiovasc Diabetol. 2013;12:156. [Crossref]
  9. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2:536-43. [Crossref]
  10. de Vos AM, Prokop M, Roos CJ, et al. Peri-coronary epicardial adipose tissue is related to cardiovascular risk factors and coronary artery calcification in post-menopausal women. Eur Heart J. 2008;29:777-83. [Crossref]
  11. Aslan AN, Keleş T, Ayhan H, et al. The Relationship between Epicardial Fat Thickness and Endothelial Dysfunction in Type I Diabetes Mellitus. Echocardiography. 2015;32:1745-53. [Crossref]
  12. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14-22. [Crossref]
  13. Savant JD, Furth SL, Meyers KEC. Arterial Stiffness in Children: Pediatric Measurement and Considerations. Pulse (Basel). 2014;2:69-80. [Crossref]
  14. Gajdova J, Karasek D, Goldmannova D, et al. Pulse wave analysis and diabetes mellitus. A systematic review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161:223-33. [Crossref]
  15. American Diabetes Association Professional Practice Committee . 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45:S17-38. [Crossref]
  16. Demir K, Özen S, Konakçı E, Aydın M, Darendeliler F. A Comprehensive Online Calculator for Pediatric Endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol. 2017;9:182-4. [Crossref]
  17. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140:e20171904. [Crossref]
  18. Franssen PML, Imholz BPM. Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria. Blood Press Monit. 2010;15:229-31. [Crossref]
  19. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588-605. [Crossref]
  20. Baulmann J, Schillings U, Rickert S, et al. A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods. J Hypertens. 2008;26:523-8. [Crossref]
  21. Shah AS, Wadwa RP, Dabelea D, et al. Arterial stiffness in adolescents and young adults with and without type 1 diabetes: the SEARCH CVD study. Pediatr Diabetes. 2015;16:367-74. [Crossref]
  22. Chambers MA, Shaibi GQ, Kapadia CR, et al. Epicardial adipose thickness in youth with type 1 diabetes. Pediatr Diabetes. 2019;20:941-5. [Crossref]
  23. Li Y, Liu B, Li Y, et al. Epicardial fat tissue in patients with diabetes mellitus: a systematic review and meta-analysis. Cardiovasc Diabetol. 2019;18:3. [Crossref]
  24. Raafat S, Ahmed R, Mowafi I, Adel H. Relation between the Epicardial Fat Thickness and the Cardiac Conduction System in Children and Adolescents with Diabetes. Horm Res Paediatr. 2024;97:496-508. [Crossref]
  25. Ahmad FA, Metwalley KA, Mohamad IL. Association of Epicardial Fat with Diastolic and Vascular Functions in Children with Type 1 Diabetes. Pediatr Cardiol. 2022;43:999-1010. [Crossref]
  26. Iacobellis G, Diaz S, Mendez A, Goldberg R. Increased epicardial fat and plasma leptin in type 1 diabetes independently of obesity. Nutr Metab Cardiovasc Dis. 2014;24:725-9. [Crossref]
  27. Momesso DP, Bussade I, Epifanio MA, Schettino CDS, Russo LAT, Kupfer R. Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome. Diabetes Res Clin Pract. 2011;91:47-53. [Crossref]
  28. Yazıcı D, Özben B, Yavuz D, et al. Epicardial adipose tissue thickness in type 1 diabetic patients. Endocrine. 2011;40:250-5. [Crossref]
  29. Liao M, Chen S, Guo R. Association between carotid ultrasonographic parameters and microvascular and macrovascular complications in diabetes: a systematic review and meta-analysis. J Diabetes Complications. 2023;37:108554. [Crossref]
  30. Urbina EM, Williams RV, Alpert BS, et al. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension. 2009;54:919-50. [Crossref]
  31. Giannopoulou EZ, Doundoulakis I, Antza C, et al. Subclinical arterial damage in children and adolescents with type 1 diabetes: A systematic review and meta-analysis. Pediatr Diabetes. 2019;20:668-77. [Crossref]
  32. Parikh A, Sochett EB, McCrindle BW, Dipchand A, Daneman A, Daneman D. Carotid artery distensibility and cardiac function in adolescents with type 1 diabetes. J Pediatr. 2000;137:465-9. [Crossref]
  33. Glackin S, Islam N, Henderson AM, et al. Ambulatory blood pressure and carotid intima media thickness in children with type 1 diabetes. Pediatr Diabetes. 2020;21:358-65. [Crossref]
  34. Krantz JS, Mack WJ, Hodis HN, Liu CR, Liu CH, Kaufman FR. Early onset of subclinical atherosclerosis in young persons with type 1 diabetes. J Pediatr. 2004;145:452-7. [Crossref]
  35. Christoforidis A, Georeli I, Dimitriadou M, Galli-Tsinopoulou A, Stabouli S. Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta-analysis. Diabetes Metab Res Rev. 2022;38:e3555. [Crossref]
  36. Tynjälä A, Forsblom C, Harjutsalo V, Groop PH, Gordin D; FinnDiane Study Group . Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes. Diabetes Care. 2020;43:2266-71. [Crossref]
  37. Duarte SV, de Souza Rajão J, Pinho JF, et al. Changes in aortic pulse wave components, pulse pressure amplification, and hemodynamic parameters of children and adolescents with type 1 diabetes. Pediatr Diabetes. 2019;20:202-9. [Crossref]
  38. Obermannova B, Petruzelkova L, Sulakova T, Sumnik Z. HbA1c but not diabetes duration predicts increased arterial stiffness in adolescents with poorly controlled type 1 diabetes. Pediatr Diabetes. 2017;18:304-10. [Crossref]
  39. McEniery CM, Yasmin , Hall IR, et al. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005;46:1753-60. [Crossref]
  40. Terlemez S, Bulut Y, Ünüvar T, Tokgöz Y, Eryilmaz U, Çelik B. Evaluation of arterial stiffness in children with type 1 diabetes using the oscillometric method. J Diabetes Complications. 2016;30:864-7. [Crossref]
  41. Wadwa RP, Urbina EM, Anderson AM, et al. Measures of arterial stiffness in youth with type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2010;33:881-6. [Crossref]