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Reduced vascular reactivity in diabetic children and its relation to diabetic control
Insights
Children with type 1 diabetes show reduced vascular reactivity, impacting blood flow after ischemia. Poor glycemic control, especially nighttime urinary glucose excretion, significantly correlates with this impaired vascular function.
Area of Science:
- Vascular Biology
- Pediatric Endocrinology
- Diabetes Research
Background:
- Type 1 diabetes mellitus (T1DM) is associated with microvascular complications.
- Assessing vascular function in diabetic children is crucial for early intervention.
Purpose of the Study:
- To investigate vascular reactivity in children with T1DM using a non-invasive method.
- To determine the correlation between vascular reactivity and diabetic control parameters.
Main Methods:
- Transcutaneous oxygen tension measurement at 37°C to assess post-ischaemic hyperaemia.
- Comparison between 28 children with T1DM and 34 healthy children.
- Correlation analysis with various glycemic control indicators (urinary glucose, HbA1c, fasting glucose, triglycerides, cholesterol, insulin dosage).
Main Results:
- Diabetic children exhibited significantly reduced post-ischaemic hyperaemia compared to healthy controls.
- Urinary glucose excretion during the night showed the strongest negative correlation with peak post-occlusive reactive hyperaemia (r = -0.59, p < 0.01).
- Vascular reactivity was influenced by a combination of factors including urinary glucose, plasma glucose, HbA1, lipids, diabetes duration, and insulin dosage, explaining 54% of the variation.
Conclusions:
- Reduced vascular reactivity is evident in children with T1DM, independent of typical carbohydrate control measures alone.
- The non-invasive transcutaneous oxygen tension method effectively detects early vascular dysfunction in diabetic children.
- This method holds promise for identifying underlying causes of vascular dysfunction in diabetes.
Abstract:
The vascular reactivity in response to ischaemia was studied by a non-invasive method of measuring transcutaneous oxygen tension used at 37 degrees C, in 28 children with type I diabetes mellitus. Postischaemic hyperaemia was significantly reduced in the diabetic children compared with 34 healthy children. The degree of reduction in vascular reactivity correlated to both short-term and long-term diabetic control. Among tested variables, urinary glucose excretion during the night preceding the test showed the highest coefficient of correlation to the peak of the postocclusive reactive hyperaemia (r = -0.59, p less than 0.01). This peak was only weakly correlated to triglycerides and glycosylated haemoglobins and showed no significant correlation to fasting plasma glucose or to the duration of the disease. It was weakly correlated to the total daily insulin dosage but not to the dosage of insulin/kg body weight. Multiple linear regression analysis revealed that urinary glucose excretion, plasma glucose, haemoglobin A1, serum triglyceride and serum cholesterol, duration of diabetes, and insulin dosage per kg body weight together explained 54% of the variation in vascular reactivity. The reduced vascular reactivity found in diabetic children could not be explained by the usual parameters of carbohydrate control alone. This new non-invasive method is able to reveal a reduction in vascular function in diabetic children and should therefore be of value in attempts to find the causes of vascular dysfunction in diabetics.