Longitudinal study of the endothelial function in children and adolescents affected by type 1 diabetes mellitus

Introduction: Cardiovascular diseases are the main cause of mortality and morbidity in patients affected by Type 1 Diabetes. The endothelial dysfunction, a precocious stage of the atherosclerotic process, can be analyzed through the brachial flow-mediated dilatation and through the evaluation, of the arterial stiffness. Objective: The aim of this study is to evaluate the presence of subclinical cardiovascular alterations and their development in pediatric patients with T1DM. Methods: A total of 42 patients with T1DM (18 females, 11.5 ± 3.6 years) entered this study. In all patients we analyzed the auxological, laboratory and clinical data (CT, HDL, LDL, TG, Glycemia, HbA1c, blood pressure (SBP-DBP). The evaluation of the endothelial function was obtained through the flow mediated dilation method (FMD), while stiffness was measured using pulse wave analysis (PWA). The measurements were repeated after 2 years and were compared with 30 healthy children and adolescents. Results: At baseline FMD values were significantly reduced in children with T1DM (4.32 ± 8.36%; vs. 9.78 ± 6.1, P = 0.003) and the lipid values result normal with a significant improvement during the study (P < 0.05). After 2 years while FMD significantly impaired, HbA1c and lipid values remained unchanged. The regression model allowed to identify CT (b = 0.683, P = 0.025) and LDL (b = )0.676, P = 0.025) as FMD predictive factors. The PWA analysis showed in females a slight decrease in myocardial perfusion. Conclusions: This study confirms that in children with T1DM the endothelial function can be already altered. The Pulse Wave Analysis results helpful to precociously individuate pathological alterations of the arterial elasticity and stratification of the cardiovascular risk.