Evaluation of arterial stiffness in children and adolescents followed with type 1 diabetes mellitus

This study aims to determine the risk of arterial stiffness using the oscillometric method in the healthy control group and the patient group, who were followed up with the diagnosis of Type 1 DM for at least five years without diabetic complications to evaluate the duration, degree, and blood pressure levels of hyperglycemia, which are predisposing factors for arterial stiffness. In addition, this study evaluates the relationship between possible subclinical myocardial damage and arterial stiffness by performing 3D/4D strain echocardiographic imaging on patients. Children and adolescents (n:51) in Gaziantep University Faculty of Medicine, Pediatric Endocrinology Outpatient Clinic who were diagnosed with Type 1 DM for at least five years and did not have diabetic complications were included in the study. The control group composed of patients (n:51) who applied to Gaziantep University Pediatric Cardiology Outpatient Clinic with the complaint of innocent murmur and non-specific chest pain, without any additional disease (n:51) while considering the similar age and body mass index. Anthropometric measurements of all cases were performed. In the diabetic patient group, the average values of HbA1c, which was routinely checked in the last year, were recorded. The diabetic patient group was divided into two groups as HbA1c≤ 9 (n:27) moderately controlled Type 1 DM, and HbA1c>9 (n:24) uncontrolled Type 1 DM. Pulse wave analysis measurement of all cases was performed with an automatic oscillometric device (Mobil-O-Graph, IEM). On the same day, 2D echocardiography and 3D/4D strain echocardiography imaging were performed by same user with Vivid E9 XD Clear echocardiography device. Image processing was done offline with the EchoPAC software. There was no significant difference in age (13.81±2.58, 13.37±2.29, respectively), body mass index (BMI) levels (20.91±4.59, 20.83±4.09, respectively) and F/M sex ratios (23/18, 25/26, respectively) between the patient and control groups (p=0.362, p=0.922 ve p=0.843) group. Considering the heart rate and blood pressure values; Systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) values (113.64±10mmHg, 68.35±8.50 mmHg, and 89.04±8.03 mmHg) was higher in the patient group compared to the control group (109.90±9.47 mmHg, 66.23±6.31 mmHg and 85.45±6.81 mmHg). The differences found to be statistically significant only for MAP (p=0.185, p=0.356 and p=0.017). In the comparison of the groups in terms of oscillometric measurement values, the pulse wave velocity (PWV), reflectance amplitude and amplification index values [4.8 m/s (4.1-5.8), 56.3 (28.8-69.0) and 36.23±9.67] were compared to the control group [4.3 m/sec.] (3.9-5.1), 50.0 (37.6-66.0) and 28.25±7.70] were found to be statistically significantly higher (p<0.001, p<0.001 and p<0.001, respectively). It was determined that the environmental resistance values (1581.57±166.18) in the patient group were higher than the control group (1550.46±130), but the difference vii was not statistically significant (p=0.296). Although echocardiographic measurements showing systolic and diastolic functions compared between two groups, it was determined that the differences were not statistically significant (p>0.05). Two groups were compared in terms of 4D strain echocardiographic measurement values and it was found that radial strain (RS) values were higher in the patient group. Circumferential strain (CS) and arial strain (AS) values also were higher in the patient group, but the difference was not statistically significant (p> 0.05). Longitudinal strain (LS) data were found to be same level and similar values between the groups (p>0.05). It was determined that PWV, elevation index and perimeter resistance measurements were higher in the uncontrolled diabetes group (n:24) than in the moderately controlled diabetes group (n:27), but the differences were not statistically significant (p=0.200, p=0.895 and p, respectively). =0.698). It was found that there was no significant correlation between disease duration and PWV, elevation index measurement values in the patient group (r=0.085, p=0.555, r= -0.176, p=0.217, respectively). In children and adolescents with type 1 diabetes mellitus, arterial stiffness parameters Pulse Wave Velocity (PWV) and augmentation index (AIx) were found to be significantly higher than the control group. This study showed that arterial stiffness may have increased in the patient group who did not develop diabetes complications. Also duration of diabetes was not found to be correlated with arterial stiffness. There was no significant difference in systolic and diastolic functions in the patient and control groups. 3D/4D strain echocardiography imaging performed to show subclinical myocardial damage. No significant difference was found between the two groups in terms of strain values. This was associated with insufficient time passed for myocardial damage to develop.