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Hypoglycemia, but not glucose variability, relates to vascular function in children with type 1 diabetes

Alexia S Peña1, Jennifer J Couper, Jennifer Harrington

  • 1Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, South Australia, Australia. alexia.pena@adelaide.edu.au

Diabetes Technology & Therapeutics
|February 9, 2012
PubMed

Insights

Hypoglycemia, not glucose variability, is linked to impaired vascular function in children with type 1 diabetes. This suggests hypoglycemia may be an early cardiovascular disease risk factor.

Area of Science:

  • Pediatric Endocrinology
  • Cardiovascular Health
  • Diabetes Research

Background:

  • Chronic hyperglycemia is a known predictor of vascular disease in diabetes.
  • The impact of glucose variability and hypoglycemia on vascular risk in type 1 diabetes is not well understood.
  • Vascular dysfunction, a precursor to atherosclerosis, is observed in children with type 1 diabetes.

Purpose of the Study:

  • To investigate the relationship between glucose variability and vascular function in children with type 1 diabetes.
  • To determine if glucose variability or hypoglycemia is associated with impaired vascular endothelial function.

Main Methods:

  • Continuous glucose monitoring data (48 hours) were collected from 52 children with type 1 diabetes.
  • Glucose variability (mean amplitude of glycemic excursions [MAGE]) and hypoglycemia indices (glycemic risk assessment diabetes equation [GRADE], Low Blood Glucose Index [LBGI]) were assessed.
  • Vascular function was evaluated using flow-mediated dilatation (FMD) and glyceryl trinitrate-mediated dilatation (GTN) in subjects and controls.

Main Results:

  • Children with type 1 diabetes exhibited significantly lower FMD and GTN compared to controls.
  • Hypoglycemia indices (GRADE and LBGI) were inversely correlated with FMD, indicating poorer vascular function with more hypoglycemia.
  • Glucose variability measures (MAGE) did not show a significant relationship with FMD or GTN.

Conclusions:

  • Hypoglycemia, specifically, is associated with impaired vascular endothelial function in children with type 1 diabetes.
  • Hypoglycemia may represent an additional risk factor for early cardiovascular disease in this population.
  • The independent effect of glucose variability on vascular function, separate from glycosylated hemoglobin, requires further investigation.
Abstract

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