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Impaired vascular reactivity during the first two years of diabetes mellitus after initial restoration
A M Kobbah1, U Ewald, T Tuvemo
1Department of Pediatrics, University Hospital, Uppsala, Sweden.
Insights
Vascular reactivity in children with type I diabetes mellitus (IDDM) was initially impaired but normalized with treatment. However, it decreased again after two years, suggesting early diabetic microangiopathy.
Area of Science:
- Pediatrics
- Endocrinology
- Vascular Biology
Background:
- Type I diabetes mellitus (IDDM) can affect vascular function in children.
- Early detection of vascular changes is crucial for managing long-term complications.
Purpose of the Study:
- To investigate vascular reactivity in children newly diagnosed with IDDM.
- To assess changes in vascular reactivity over 24 months of diabetes management.
- To explore correlations between vascular reactivity and clinical/biochemical variables.
Main Methods:
- Prospective study of 36 children with newly diagnosed IDDM and 58 healthy controls.
- Measurement of skin postocclusive hyperemia using a transcutaneous oxygen electrode.
- Repeated measurements at diagnosis, and 1, 6, 12, and 24 months post-diagnosis.
Main Results:
- Diabetic children showed significantly lower vascular reactivity on admission compared to controls.
- Vascular reactivity normalized within the first month of insulin treatment.
- After 24 months, vascular reactivity was again significantly reduced in diabetic children.
- Serum magnesium correlated with vascular reactivity at 6 months post-diagnosis.
Conclusions:
- The initial impairment in vascular reactivity is reversible with treatment.
- The late reduction in vascular reactivity may indicate early diabetic microangiopathy.
- Vascular reactivity assessment can be a sensitive indicator of early diabetic complications in children.
Abstract:
Vascular reactivity was studied prospectively in 36 consecutive children (15 males, 21 females) below 15 years from the county of Uppsala with newly acquired type I diabetes mellitus (IDDM). Skin postocclusive hyperaemia was recorded with a transcutaneous oxygen electrode at 37 degrees C on admission before receiving insulin treatment and 1, 6, 12 and 24 months after diagnosis. Fifty-eight healthy children (25 males, 33 females), served as a reference group. The relations between vascular reactivity and age, sex and a number of biochemical variables that are often disturbed in IDDM were analyzed. On admission, the vascular reactivity was significantly lower in diabetic children than in controls (p less than 0.001). This reduction was normalized during the first month of treatment. After two years of diabetes, the vascular reactivity was again significantly lower in diabetic children than in the control group (p less than 0.001). There was no significant correlation between the vascular reactivity, the lag phase or baseline variables and any of the factors mentioned above at any time of investigation, except that serum magnesium was significantly correlated with vascular reactivity after six months of IDDM. It is suggested that the mechanism underlying an impairment of vascular reactivity on admission (reversible) is different from that of the late reduction, which might be a very early manifestation of the later structural diabetic microangiopathy.