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Vascular reactivity during the first year of diabetes in children
Insights
Newly diagnosed type 1 diabetes impairs vascular reactivity in children, but this improves with early insulin treatment. Further research is needed to understand the causes of abnormal vascular function beyond glucose control.
Area of Science:
- Pediatrics
- Endocrinology
- Vascular Physiology
Background:
- Type 1 diabetes mellitus (T1DM) can affect vascular function.
- Early diagnosis and treatment are crucial for managing T1DM in children.
Purpose of the Study:
- To investigate the functional vascular response to hypoxia in children with newly diagnosed T1DM.
- To assess changes in vascular reactivity during the first year of T1DM management.
Main Methods:
- Prospective study of 24 children with T1DM over one year.
- Non-invasive measurement of postocclusive reactive hyperaemia using transcutaneous PO2 at 37°C.
- Repeated experiments before and at multiple time points after insulin treatment initiation.
Main Results:
- Impaired vascular reactivity was observed in children with T1DM at diagnosis compared to controls.
- Vascular reactivity showed significant improvement by 180 days of treatment, reaching control levels.
- No significant correlation was found between vascular reactivity and glycemic control indicators (urine glucose, blood glucose, HbA1c).
- A slight decrease in vascular reactivity was noted at 360 days.
Conclusions:
- Impaired vascular reactivity in T1DM is detectable before insulin treatment and improves with early management.
- Factors other than carbohydrate control appear to influence abnormal vascular function in newly diagnosed T1DM.
- Further investigation into non-glycemic factors is warranted to explain vascular abnormalities.
Abstract:
Functional vascular response to hypoxia was studied in 24 children followed up prospectively for one year after diagnosis of type 1 diabetes mellitus. Postocclusive reactive hyperaemia was detected non-invasively in the skin using a transcutaneous PO2 method at 37 degrees C. Repeated experiments under standardized conditions were performed before institution of insulin treatment and 3, 7, 21, 30, 180 and 360 days after diagnosis. Impaired vascular reactivity was noted at the first experiment as compared with control children and slight but significant improvement was then noted up to the experiment at 180 days (p less than 0.01). At 30 and 180 days no significant difference between diabetic and control children was found. A small decrease in mean postocclusive reactive hyperaemia was observed at the experiment performed after 360 days. Fast normalization of urine glucose excretion, blood glucose and haemoglobin A1 occurred during the first three weeks of treatment but these variables showed no significant correlation to vascular reactivity, either at diagnosis or later. Impaired vascular reactivity can thus be diagnosed even before the institution of insulin treatment and improves during the first months of treatment, reaching the range of controls. Other factors than indicators of carbohydrate control have to be studied in the search for explanations of the abnormal vascular function in newly diagnosed diabetic children.