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Pearson's linear correlation scatter plot of the percentage of maximal flow-mediated dilation (FMD %) versus fasting glucose levels.
Source publication
Objective
The purpose of this study was to verify the presence of endothelial dysfunction and initial structural atherosclerotic changes in children with Type 1 diabetes mellitus (T1DM).
Subjects and methods
The study population comprised 31 diabetic children aged 6 to 12 years, divided into two subgroups according to the duration of the T1DM diag...
Contexts in source publication
Context 1
... linear correlation coefficient, which evaluates the correlation between two measurable variables, was applied to determine the presence of a relationship between the FMD (%) and serum levels of HbA1c (Figure 1), and FMD (%) and fasting glucose (Figure 2). The test revealed a moderately negative correlation between FMD (%) and HbA1c (r = -0.36, ...
Context 2
... = 0.0025) and between FMD (%) and fasting glucose (r = -0.36, p = 0.0024) (Figure 2). As these correlations were negative, the coefficient suggested that the higher the level of HbA1c and fasting glucose, the lower the FMD (%), confirming our hypothesis. ...
Context 3
... the imbalance between the production of endothelium-derived factors impairs the vascular tonus and other physiological properties of the vascular endothelium (3), favoring vasoconstriction (18) and an inflammatory state (4), perpetuated by the long-lasting hyperglycemia (19). The results of Pearson's correlation coefficients corroborate these claims in our population, suggesting a moderate association between decreased vasodilation and increased serum levels of HbA1c and fasting glucose (Figures 1 and 2, respectively). On reviewing the FMD technique protocol, we found a disagreement among several authors regarding the degree of occlusion to be applied. ...
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Citations
... Skilton et al. reviewed the relationship between atherosclerosis and aortic intimal thickness and concluded that the relationship between these two factors is apparent, taking into account the gaps and weaknesses of previous studies (17). ...
Background
Preterm infants with bronchopulmonary dysplasia (BPD) often experience systemic hypertension, but the exact cause is not yet known. Since there have been no previous studies on the relationship between systemic hypertension and aortic thickness, we conducted this study to evaluate and compare various vascular indices among preterm neonates with BPD, preterm neonates without BPD, and healthy neonates using abdominal aorta ultrasonography.
Methods
In this cross-sectional study 20 preterm neonates, 20 preterm neonates with BPD, and 20 healthy neonates who were matched for gestational age, weight, sex, and age were included. Demographic, anthropometric, and clinical examination data were recorded. The neonates underwent abdominal aortic ultrasonography to compare the aortic wall thickness and vasomotor function among the three groups.
Results
The study found that neonates with BPD had a significantly higher mean systolic blood pressure compared to preterm and term neonates(P < 0.05). There was no significant difference in echocardiographic variables including SVR, input impedance, and arterial wall stiffness index among the three groups(P > 0.05). Mean (SD) of aIMT in preterm neonates with BPD, preterm and term neonates were 814(193.59), 497.50(172.19) and 574.00(113.20), respectively(P < 0.05). Mean (SD) of pulsatile diameter in preterm neonates with BPD, preterm and term neonates were 1.52(0.81), 0.91(0.55) and 1.34(0.51), respectively(P < 0.05). After adjusting for birth weight, sex, and gestational age, the study found a significant association between aIMT and BPD.
Conclusion
The study concluded that the mean aortic intima-media thickness (aIMT) was significantly higher in preterm neonates with BPD, which could be an early marker of atherosclerosis and predisposition to higher blood pressure and cardiovascular issues in the future. Therefore, the study suggests that aIMT could be used as a reproducible and well-tolerated marker to identify patients with BPD who are at risk for developing these health issues.
... Several surrogate indices are used in clinical practice to assess early vascular abnormalities (Table 3). Young patients with T1D showed delayed or reduced brachial artery flow mediated dilatation (FMD) reactivity and higher carotid femoral pulse wave velocity (PWV), as compared to healthy controls [53,54,59,68,78,[91][92][93][94][95][96]. On the other hand, Bradley et al. demonstrated that carotid-radial PWV, but not carotid-femoral PWV, is higher in adolescents with T1D than in healthy controls [93]. ...
The prevalence of diabetes mellitus is rising among children and adolescents worldwide. Cardiovascular diseases are the main cause of morbidity and mortality in diabetic patients. We review the impact of diabetes on establishing, during childhood and adolescence, the premises for cardiovascular diseases later in life. Interestingly, it seems that hyperglycemia is not the only factor that establishes an increased cardiovascular risk in adolescence. Other factors have been recognized to play a role in triggering the onset of latent cardiovascular diseases in the pediatric population. Among these cardiovascular risk factors, some are modifiable: glucose variability, hypoglycemia, obesity, insulin resistance, waist circumference, hypertension, dyslipidemia, smoking alcohol, microalbuminuria and smoking. Others are unmodifiable, such as diabetes duration and family history. Among the etiological factors, subclinical endothelial dysfunction represents one of the earliest key players of atherosclerosis and it can be detected during early ages in patients with diabetes. A better assessment of cardiovascular risk in pediatric population still represents a challenge for clinicians, and thus further efforts are required to properly identify and treat pediatric patients who may suffer from cardiovascular disease later in early adulthood.
... Endothelial dysfunction is known to be present in T1DM patients [52][53][54] and recent research suggests that endothelial dysfunction may already emerge in diabetic children, even if no atherosclerotic structural changes have been observed yet 38,55 . Increased isoprene concentrations in T1DM patients thus may reflect damages at the cellular level that will translate in altered physiological properties of the endothelium. ...
Monitoring metabolic adaptation to type 1 diabetes mellitus in children is challenging. Analysis of volatile organic compounds (VOCs) in exhaled breath is non-invasive and appears as a promising tool. However, data on breath VOC profiles in pediatric patients are limited. We conducted a cross-sectional study and applied quantitative analysis of exhaled VOCs in children suffering from type 1 diabetes mellitus (T1DM) (n = 53) and healthy controls (n = 60). Both groups were matched for sex and age. For breath gas analysis, a very sensitive direct mass spectrometric technique (PTR-TOF) was applied. The duration of disease, the mode of insulin application (continuous subcutaneous insulin infusion vs. multiple daily insulin injection) and long-term metabolic control were considered as classifiers in patients. The concentration of exhaled VOCs differed between T1DM patients and healthy children. In particular, T1DM patients exhaled significantly higher amounts of ethanol, isopropanol, dimethylsulfid, isoprene and pentanal compared to healthy controls (171, 1223, 19.6, 112 and 13.5 ppbV vs. 82.4, 784, 11.3, 49.6, and 5.30 ppbV). The most remarkable differences in concentrations were found in patients with poor metabolic control, i.e. those with a mean HbA1c above 8%. In conclusion, non-invasive breath testing may support the discovery of basic metabolic mechanisms and adaptation early in the progress of T1DM.
Over 1 million Americans are currently living with T1D and improvements in diabetes management have increased the number of adults with T1D living into later decades of life. This growing population of older adults with diabetes is more susceptible to aging comorbidities, including both vascular disease and osteoporosis. Indeed, adults with T1D have a 2- to 3- fold higher risk of any fracture and up to 7-fold higher risk of hip fracture compared to those without diabetes. Recently, diabetes-related vascular deficits have emerged as potential risks factors for impaired bone blood flow and poor bone health and it has been hypothesized that there is a direct pathophysiologic link between vascular disease and skeletal outcomes in T1D. Indeed, microvascular disease (MVD), one of the most serious consequences of diabetes, has been linked to worse bone microarchitecture in older adults with T1D compared to their counterparts without MVD. The association between the presence of microvascular complications and compromised bone microarchitecture indicates the potential direct deleterious effect of vascular compromise, leading to abnormal skeletal blood flow, altered bone remodeling, and deficits in bone structure. In addition, vascular diabetic complications are characterized by increased vascular calcification, decreased arterial distensibility, and vascular remodeling with increased arterial stiffness and thickness of the vessel walls. These extensive alterations in vascular structure lead to impaired myogenic control and reduced nitric-oxide mediated vasodilation, compromising regulation of blood flow across almost all vascular beds and significantly restricting skeletal muscle blood flow seen in those with T1D. Vascular deficits in T1D may very well extend to bone, compromising skeletal blood flow control, and resulting in reduced blood flow to bone, thus negatively impacting bone health. Indeed, several animal and ex vivo human studies report that diabetes induces microvascular damage within bone are strongly correlated with diabetes disease severity and duration. In this review article, we will discuss the contribution of diabetes-induced vascular deficits to bone density, bone microarchitecture, and bone blood flow regulation, and review the potential contribution of vascular disease to skeletal fragility in T1D.
Preterm infants with bronchopulmonary dysplasia (BPD) frequently encounter systemic hypertension, yet the underlying cause remains elusive. Given the absence of prior investigations concerning the correlation between systemic hypertension and aortic thickness, we undertook this study to assess and juxtapose diverse vascular indices amidst preterm neonates with BPD, preterm neonates lacking BPD, and healthy neonates, utilizing abdominal aorta ultrasonography. This cross-sectional study encompassed 20 preterm neonates, 20 preterm neonates with BPD, and 20 healthy neonates, meticulously matched for sex and postnatal age. Comprehensive demographic, anthropometric, and clinical evaluation data were documented. The neonates underwent abdominal aortic ultrasonography for comparative evaluation of aortic wall thickness and vasomotor function across the three groups. The study revealed that neonates with BPD exhibited a notably higher average systolic blood pressure than preterm and term neonates (P < 0.05). Conversely, echocardiographic parameters such as input impedance, and arterial wall stiffness index displayed no substantial variance among the three groups (P > 0.05). The mean (SD) aortic intima-media thickness (aIMT) for preterm neonates with BPD, preterm neonates, and term neonates were 814 (193.59) μm, 497.50 (172.19) μm, and 574.00 (113.20) μm, correspondingly (P < 0.05). Furthermore, the mean (SD) pulsatile diameter for preterm neonates with BPD, preterm neonates, and term neonates were 1.52 (0.81) mm, 0.91 (0.55) mm, and 1.34 (0.51) mm, respectively (P < 0.05). Following adjustment for birth weight, sex, and gestational age at birth, the study identified a noteworthy correlation between aIMT and BPD. The investigation concluded that the mean aortic intima-media thickness (aIMT) was significantly elevated in preterm neonates with BPD, signifying a potential early indicator of atherosclerosis and predisposition to future heightened blood pressure and cardiovascular ailments. Consequently, the study postulates that aIMT could be a consistent and well-tolerated marker for identifying BPD patients at risk of developing these health complications.
Objectives:
To detect early atherosclerosis changes using flow-mediated dilation (FMD) of the brachial artery, carotid intima-media thickness (CIMT), inflammatory markers (hs-CRP, IL-6), and endothelial markers (sICAM and sVCAM).
Methods:
The authors recruited 4 to 18-y-old children with type 1 diabetes mellitus (T1DM) and age- and sex-matched normal children, excluding those with familial hypercholesterolemia, syndromic disorders, and cardiovascular disease. CIMT and FMD were measured in both the groups. Biomarkers hs-CRP, IL-6, sICAM, and sVCAM, were analyzed in the T1DM group.
Results:
Forty T1DM children and 40 controls with 27 (67.5%) girls were enrolled in each group. The mean age was 9.68 y. The T1DM group had 4 (10%) obese and 4 (10%) overweight children. Among cases, 9 (22.5%) had diabetes for > 5 y, 24 (60%) required daily insulin between 0.8 and 1.2 IU/kg/d and 26 (65%) had HbA1c > 10 g/dL. The CIMT values were significantly higher in cases (0.69 mm) than in controls (0.59 mm); 29 (72.5%) cases had abnormal combined CIMT values. FMD was lesser in cases than in controls but not significant. The median values of hs-CRP, IL-6, sICAM, sVCAM were 0.81 mg/L, 6.27 pg/mL, 46.33 ng/mL and 668.81 ng/mL, respectively. A significant correlation of IL-6 with CIMT (r = 0.543, p = < 0.001) and sICAM with FMD (r = -0.397, p = 0.011) was observed. VCAM was low in the obese and overweight children.
Conclusion:
Children with type 1 diabetes had higher CIMT than normal children, whereas FMD did not differ. The association between elevated inflammatory markers with high CIMT and low FMD indicates that inflammation plays an essential role in endothelial dysfunction.
Background There is a correlation between diabetes mellitus type 1 (T1DM) and a higher risk of heart disease. Atherosclerosis, which can be discovered early with cIMT (Carotid Intima-Media Thickness) and Flow Mediated Dilation (FMD) tests, contributes to the development of cardiovascular disease. HbA1c fluctuation and lipid profile can have an impact on cIMT and FMD. Aim The aim of this study is to determine the influence of HbA1c variability and lipid profile on cIMT and FMD levels in children T1DM patients treated at Dr Saiful Anwar Hospital Malang. Methods The study utilized a cross-sectional design and included 82 participants with Type 1 Diabetes Mellitus who were routinely treated at the Dr. Saiful Anwar Hospital Malang's pediatric outpatient clinic between January - July 2019 and December 2021 and- January 2022. Results The correlation test revealed no significant connection between HDL (ρ=-0,029; p=0,796), LDL (ρ=-0.213; p=0.055), TG (ρ= -0.179; p= 0.107), and total cholesterol (ρ=-0.182; p= 0.101). Association tests revealed a positive correlation between LDL (ρ=0,318; p=0,004) and total cholesterol (ρ=0,230; p=0,038) levels and IMT. The correlation coefficient between HbA1C variability and FMD as evaluated by HVS was -0.498 (ρ=0.000; p=0.05), as was the correlation coefficient between HbA1c-SD (ρ=-0.467; p=0.000) and HbA1c-CV (ρ=-0.400; p=0.000). Additionally, a significant positive connection was discovered between IMT and the value of HbA1c variability utilizing HVS (ρ=0.455; p=0.000), HbA1c-SD (ρ=0.434; p=0.000), and HbA1c-CV (ρ=0.325; p=0.003). The linear regression analysis revealed that the three variables with the greatest influence on FMD were HVS (R=0.398), LDL (R=0.316), and HbA1c-SD (R=0.293). HVS (R=0.468), LDL (R=0.268), and total cholesterol (R=0.198) were the three most impactful variables on IMT. It is known that the combination of lipid profile and HbA1c fluctuation contributes 25.1% to FMD using this model. Meanwhile, the lipid profile and HbA1c variability together accounted for 34.5% of the variance in IMT. Conclusion Variability in HbA1c and lipid profile (LDL and total cholesterol) can contribute to an increase in intima-media thickness and a decrease in brachial artery FMD in children with T1DM.
Introduction Multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) are two modalities of treating type 1 diabetes mellitus (T1DM). The benefits of CSII on long-term metabolic control and outcomes compared to those of MDI are still debated. We investigated both vascular function and myocardial performance in T1DM adolescents on MDI or CSII treatment.
Methods One hundred twenty-three T1DM subjects (mean age 14.16±2.55 years), 63 on MDI regimen, 60 on CSII, and 57 controls were enrolled. Anthropometric and biochemical characteristics were evaluated. Ultrasound assessments of carotid intima-media thickness (cIMT), flow-mediated dilatation of brachial artery, anteroposterior diameter of the infrarenal abdominal aorta (APAO), and transthoracic echocardiography were performed.
Results T1DM subjects on the CSII regimen showed better glycemic control than those on MDI, expressed as glycated haemoglobin (HbA1c). c-IMT and APAO were higher in MDI than CSII patients (0.61±0.11 mm vs. 0.56±0.07 mm, p=0.04; 13.61±3.29 mm vs. 11.65±1.84 mm, p=0.01, respectively). Left and right Tei index and left E/e’ ratio were higher in MDI than CSII subjects (0.82±0.40 vs. 0.52±0.19, p=0.002; 0.86±0.41 vs. 0.64±0.1, p=0.02; 5.89±2.0 vs. 4.73±1.59, p=0.02, respectively). Multiple regression analyses showed that glucose level, HbA1c and diabetes onset were significantly related to vascular and echocardiographic parameters in MDI and CSII patients.
Conclusions CSII regimen in T1DM adolescents improves glycemic control and seems to ameliorate endothelial function and global myocardial performance as compared to MDI therapy.
Type 1 diabetes (T1DM) is a strong risk factor for the development of cardiovascular disease. Flow-mediated dilatation (FMD) is an early noninvasive marker of endothelial function and it predicts future cardiovascular disease. However, the changes in FMD among T1DM children are still controversial. The present meta-analysis aimed to investigate whether FMD is impaired in children with T1DM. PubMed, EMBASE, Cochrane library, and Web of Science were searched for studies comparing FMD in children with T1DM and healthy controls. The Newcastle-Ottawa quality assessment scale for case-control studies was used to assess study quality. Data were pooled using a random effects models to obtain the weighted mean differences (WMD) in FMD and 95% CIs. Overall, 19 studies with 1245 patients and 872 healthy controls were included in this meta-analysis. Children with T1DM had significantly lower FMDs compared with healthy controls (WMD: -2.58; 95% CI: -3.36 to -1.81; P < .001). Meta-regression analysis revealed that low-density lipoprotein cholesterol levels impacted the observed difference in FMD between T1DM and healthy children. This meta-analysis showed that T1DM children have impaired endothelial function, which indicates they are at higher risk of developing cardiovascular disease in later life.
Endothelial dysfunction is a key mechanism in the pathogenesis of complications of cardiovascular disease in Diabetes Mellitus (DM) patients. One of the new biomarkers for inflammatory conditions and endothelial dysfunction is endocan. This study aimed to determine the correlation between endocan levels and HbA1c in type 1 DM patients. This study was an analytical observational study with a cross-sectional approach performed at the Dr. Saiful Anwar Hospital, Malang from May to August 2019. The research subjects were children aged 10-18 years with a diagnosis of type 1 DM who met the inclusion criteria. Students who underwent routine health checks participated as the control group. In both groups, serum endocan levels were measured using the ELISA method and HbA1c levels were measured by the HPLC method. Independent T-test analysis was used to determine the differences between both groups and the Pearson test was used to determine the correlation between serum endocan and HbA1c with SPSS version 23. In this study, there were 40 type 1 DM patients and 40 healthy controls with a mean age of 14.5 (3.16) years in the type 1 DM group and 14.7 (0.99) years in the healthy control group. There was a higher number of female subjects in both the type 1 DM group (57.5%) and the healthy control group (65%). The mean endocan level in the type 1 DM group was higher than the control group and was statistically significant with 1090.61 (150.84) pg/mL vs. 775.56 (8.91) pg/mL, p=0.000). The mean value for HbA1c levels in the type 1 DM group was also significantly higher compared to the control group 9.63 (2.22%) vs. 4.69 (0.251%), p <0.001), respectively. There was a significant positive correlation between endocan levels and HbA1c in DM patients (p=0.025, r=0.354). This study showed a correlation between serum endocan levels and HbA1c in patients with type 1 DM.
