Investigation of endothelial dysfunction and arterial elasticity features in children with type 1 diabetes mellitus

Type 1 diabetes mellitus is a common disease with significant morbidity and mortality. The frequency is increasing. There are early and late complications. Late complications are nephropathy, retinopathy, neuropathy and coronary artery disease. Endothelial dysfunction and the impairment of arterial elasticity may play an important role in these complications. Therefore, in practice, the detection of endothelial dysfunction and impaired arterial elasticity is extremely important in terms of prevention of diabetic complications.This study was conducted in Akdeniz University Medical Faculty Hospital, Department of Pediatric Cardiology and Department of Pediatric Endocrinology. The patient group consisted of 42 patients with type 1 diabetes mellitus and a control group 42 healthy individuals. Patients, who were diagnosed with Type 1 diabetes for at least five years, with an age range between 7 and 18 years and without any diabetic complications (neuropathy, nephropathy, retinopathy, and coronary artery disease), were included in the study. In this study, endothelial dysfunction, arterial stiffness, carotid intima-media thickness, cardiac systolic and diastolic functions were investigated on patients with type 1 diabetes.In the patient group, the mean age was 13.21±2.64 years, while the control group had a mean age of 13.70±2.80 years. In the diabetic group, the mean disease duration was 6.95±1.79 years, and the mean HbA1c value was found to be 9.00±1:40. In diabetic patients, the aortic strain and the aortic distensibility were decreased (p<0.001). There was no statistically significant difference in terms of the baseline brachial artery diameter and the brachial artery diameter in the first minute (p>0.05). In the diabetic patients FMD was decreased (p<0.001), whereas CIMT was higher (p<0.05).In the diabetic group, the Doppler examination revealed a statistically significantly decreased lateral left ventricular E' wave velocity, compared to the control group (p=0.009) and the IVRT and the MPI were increased significantly (p<0.001). As compared to the control group, in the diabetic group, the left ventricular septum E' wave velocity was statistically significantly decreased (p<0.001) and the IVRT was significantly increased (p<0.001). In the diabetic group, the E-wave peak at the lateral wall of the right ventricular was statistically significantly decreased compared to the control group (p<0.001), the IVRT and the MPI were increased significantly (p<0.001).There was a positive correlation between the duration of DM and CIMT examination (r=0.585, p<0.001) and IVCT (ms) (r=0.356, p=0.02); and a negative correlation between the duration of DM and aortic strain (r=-0.483, p=0.001) and aortic distensibility (r =-0.358, p=0.02). A positive correlation was found between the FMD (%) and aortic strain (r=0.496 p<0.001) and aortic distensibility (r=0.523 p<0.001); whereas there was a negative correlation between FMD (%) and IVRT (ms) (r=-0.347, p=0.001) and MPI (r=-0.264, p=0.015). Strain was negatively correlated with CIMT (r=-0.323, p=0.003) and IVRT (ms) (r=-0.483 p<0.001) and MPI (r=-0.535 p<0.001); and positively correlated with aortic distensibility (r=0.954 p<0.001).In conclusion, in diabetic patients, who have not yet developed diabetic complications, an impairment of the endothelial dysfunction and the arterial elasticity (CIMT, arterial stiffness and diastolic dysfunction) was determined. The deterioration of the endothelial dysfunction and the arterial elasticity is a predictive marker for atherosclerosis and for possible complications, in type 1 diabetic patients, who have not yet developed diabetic complications and have preserved systolic functions. With an intensive treatment of diabetes and the improvement of glycemic control, the protection of endothelial function and arterial elasticity, and / or the early treatment of the endothelial dysfunction, the possible diabetic complications can be prevented.