Longitudinal evaluation of endothelial function in children and adolescents with type 1 diabetes mellitus: a long term follow up study.

BACKGROUND: Type 1 diabetes (T1DM) predisposes to cardiovascular disease increasing the risk to develop atherosclerosis. In pediatric population the cardiovascular risk may be evaluated examining endothelial function by a noninvasive ultrasound technique, namely flow-mediated dilation (FMD) of the brachial artery. The aims of this study were the longitudinal evaluation of the potential change in the endothelium-dependent vasomotor function in children and adolescents with T1DM and the identification of clinical and laboratory data correlated to modifications. METHODS: We studied 39 T1DM patients (20 girls and 19 boys; aged 11.2 ± 3.72 years). FMD and blood samples were obtained from all patients at baseline (time 0) and after a follow-up of at least 1 year (time 1). FMD was also evaluated in 45 healthy controls (22 boys, 23 girls) aged 10.2 ± 3.05 years. RESULTS: At time 0, 43.6% T1DM patients presented an impaired FMD. FMD at time 1 revealed a dramatic impairment of endothelial function: altered FMD values were shown in 61.5% of patients and it got worse in 74.3% of them. Longitudinally males had a greater impairment of FMD than females. At baseline multivariate analysis identified only gender as significant predictor of FMD (β = 0.470, p = 0.029). CONCLUSIONS: Because endothelial dysfunction appears earlier in diabetic children, they are at higher risk to develop atherosclerosis. Our results suggest the usefulness of FMD as a tool to stratify pediatric T1DM patients according to their cardiovascular risk and to follow up them longitudinally.