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Impaired microvascular hyperaemic response in children with diabetes mellitus
A C Shore1, K J Price, D D Sandeman
1Diabetes Research Laboratories, Postgraduate Medical School, University of Exeter, UK.
Insights
Diabetic children, even before puberty, show impaired microcirculation function. This suggests early functional changes in small blood vessels occur in pediatric diabetes without clinical complications.
Area of Science:
- Pediatric endocrinology
- Vascular physiology
- Diabetes complications
Background:
- Microvascular complications of diabetes are rare in children, particularly prepubertal ones.
- Subtle functional microcirculatory abnormalities may exist in children with diabetes before clinical signs appear.
- Investigating pre-pubertal microvascular function is crucial for early diabetes management.
Purpose of the Study:
- To assess microcirculatory function in diabetic children compared to non-diabetic controls.
- To determine if functional microvascular abnormalities are present before puberty in pediatric diabetes.
- To investigate the relationship between microvascular response, diabetes duration, and glycemic control.
Main Methods:
- Laser Doppler fluximetry was used to measure the maximum hyperaemic response to local heating (44°C) of foot skin.
- Study included 50 diabetic and 50 non-diabetic children.
- Blood pressure was also measured in prepubertal children.
Main Results:
- Diabetic children exhibited an impaired hyperaemic response compared to controls (1.25 V vs. 1.74 V, p < 0.001).
- This impaired response correlated with diabetes duration but not long-term glycemic control.
- Functional abnormalities were evident even in prepubertal diabetic children, who also had elevated blood pressure.
Conclusions:
- Functional microcirculatory abnormalities occur in children with diabetes, independent of clinical microangiopathy.
- These functional changes are detectable before puberty, indicating early vascular dysfunction in pediatric diabetes.
- Early detection of microvascular changes may inform future preventative strategies for diabetes complications.
Abstract:
Clinically detectable microvascular complications of diabetes are uncommon in children with diabetes especially in the prepubertal group. It is unclear whether subtle functional abnormalities of the microcirculation occur in children without evidence of clinical microangiopathy and in particular whether abnormalities can be demonstrated in children before puberty. The maximum hyperaemic response to direct local heating (44 degrees C) of the foot skin was measured by laser Doppler fluximetry in 50 diabetic and 50 non-diabetic children. An impaired hyperaemic response occurred in the diabetic children compared with control children (diabetic 1.25 (95% CI 1.13-1.37) V; control 1.74 (1.60-1.88) V; p less than 0.001) and was significantly related to duration of diabetes but not to long-term blood glucose control. The impaired response was also present in prepubertal diabetic children (diabetic 1.37 (1.16-1.58) V; control 1.89 (1.67-2.12) V; p less than 0.001). Systolic and diastolic blood pressure were significantly raised in the prepubertal diabetic children. These data suggest that a functional abnormality of the microcirculation occurs in children with diabetes in the absence of clinically detectable microangiopathy, and even before puberty.