Epicardial adipose tissue in type 1 diabetes mellitus: a systematic review and meta-analysis

Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot surrounding the myocardium and evidence suggests its potential role in the development of cardiovascular complications in type 1 diabetes mellitus (T1DM). This systematic review and meta-analysis aimed to: (1) quantify EAT measurements (thickness and volume) in patients with T1DM, and (2) compare EAT measurements between T1DM patients and healthy controls.

A comprehensive literature review was conducted using a systematic search strategy to identify studies that measured EAT thickness or volume in T1DM patients in PubMed, Embase, Cochrane Library, Web of Science, and CINAHL. Studies were included if they: (1) involved patients with T1DM, (2) reported EAT measurements using imaging techniques, and (3) were published in English. Case reports and reviews were excluded. Two independent reviewers performed study selection, data extraction, and quality assessment. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical heterogeneity was assessed using I² statistics. Meta-analysis was performed using a random effect model.

A total of nine studies involving 285 and 233 participants measuring thickness and volume with T1DM were included. The pooled mean EAT thickness was 5.81 mm (95%CI: 4.30, 7.32 mm), and the pooled mean EAT volume was 56.84cm³ (95%CI: 34.05, 79.63cm³). Significant heterogeneity was observed between the volume and thickness of EAT among people with T1DM (I² = 99% for volume and 95% for thickness). Subgroup analysis revealed a mean difference of 2.12 mm (95%CI: 0.82, 3.43 mm) in EAT thickness between T1DM and control groups.

Our findings indicate increased EAT measurements in T1DM patients compared to healthy individuals, suggesting EAT's potential involvement in T1DM-related cardiovascular issues.