CONTEXT: Cardiovascular disease caused by atherosclerosis is a major cause of morbidity and mortality in adult diabetic patients. In children, we detected signs of subclinical atherosclerosis in a large patient cohort. This study reports the results of a longitudinal observation in this patient group. PATIENTS AND METHODS: Of the 37/150 diabetic children in whom an increased intima-media thickness (IMT) of the carotid artery had been found, 27 (mean age 14.6 +/- 2.6 yrs) could be reevaluated 2 yrs after the initial study. Of the 27, 5 patients were on medication with angiotensin-converting enzyme (ACE) inhibitors, and all patients underwent detailed counselling of their lifestyle, sports activity, and nutritional habits. RESULTS: Mean IMT increased significantly (0.49 +/- 0.02 mm vs. 0.51 +/- 0.026 mm, p < 0.05) However, there was no significant change compared to normal values (mean IMT z-score 2.4 +/- 0.3 vs. 2.6 +/- 0.5). Of the 27, 13 patients (48%) showed a progression of the IMT whereas in 14/27 patients the IMT values remained stable. In these subgroups, patients with IMT progression showed a higher hemoglobin A1c (HbA1c) (7.5 +/- 0.8 vs. 7.1 +/- 0.7, p < 0.05) and a slightly higher systolic blood pressure (120 +/- 14.4 vs. 113.9 +/- 12.1, p = 0.08). CONCLUSIONS: In a well-selected group of diabetic children, mean IMT progression during a 2-yr period did not exceed the physiological increase. Children with a higher HbA1c and a higher systolic blood pressure showed a progression of the IMT. Control of atherogenic risk factors in diabetic children may help to avoid subclinical atherosclerosis progression.
CONTEXT: Cardiovascular disease caused by atherosclerosis is a major cause of morbidity and mortality in adult diabeticpatients. In children, we detected signs of subclinical atherosclerosis in a large patient cohort. This study reports the results of a longitudinal observation in this patient group. PATIENTS AND METHODS: Of the 37/150 diabeticchildren in whom an increased intima-media thickness (IMT) of the carotid artery had been found, 27 (mean age 14.6 +/- 2.6 yrs) could be reevaluated 2 yrs after the initial study. Of the 27, 5 patients were on medication with angiotensin-converting enzyme (ACE) inhibitors, and all patients underwent detailed counselling of their lifestyle, sports activity, and nutritional habits. RESULTS: Mean IMT increased significantly (0.49 +/- 0.02 mm vs. 0.51 +/- 0.026 mm, p < 0.05) However, there was no significant change compared to normal values (mean IMT z-score 2.4 +/- 0.3 vs. 2.6 +/- 0.5). Of the 27, 13 patients (48%) showed a progression of the IMT whereas in 14/27 patients the IMT values remained stable. In these subgroups, patients with IMT progression showed a higher hemoglobin A1c (HbA1c) (7.5 +/- 0.8 vs. 7.1 +/- 0.7, p < 0.05) and a slightly higher systolic blood pressure (120 +/- 14.4 vs. 113.9 +/- 12.1, p = 0.08). CONCLUSIONS: In a well-selected group of diabeticchildren, mean IMT progression during a 2-yr period did not exceed the physiological increase. Children with a higher HbA1c and a higher systolic blood pressure showed a progression of the IMT. Control of atherogenic risk factors in diabeticchildren may help to avoid subclinical atherosclerosis progression.
Authors: Robert Dalla Pozza; Andreas Beyerlein; Claude Thilmany; Claudia Weissenbacher; Heinrich Netz; Heinrich Schmidt; Susanne Bechtold Journal: Cardiovasc Diabetol Date: 2011-06-16 Impact factor: 9.951
Authors: Elaine M Urbina; Dana Dabelea; Ralph B D'Agostino; Amy S Shah; Lawrence M Dolan; Richard F Hamman; Stephen R Daniels; Santica Marcovina; R Paul Wadwa Journal: Diabetes Care Date: 2013-04-05 Impact factor: 19.112