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Parameters of Micro- and Macrocirculation in Young Uncomplicated Type 1 Diabetic Patients-The Role of Metabolic
Jolanta Neubauer-Geryk1, Małgorzata Myśliwiec2, Katarzyna Zorena3
1Clinical Physiology Unit, Medical Simulation Centre, Medical University of Gdańsk, 80-204 Gdańsk, Poland.
Insights
Disease duration, not metabolic memory, significantly impacts early microvascular changes in pediatric type 1 diabetes. Shorter diabetes duration in youth is linked to improved microcirculation and lower inflammatory markers.
Area of Science:
- Endocrinology
- Cardiovascular Research
- Pediatric Medicine
Background:
- Metabolic memory, the persistence of metabolic disturbances despite glycemic control, is implicated in diabetes complications.
- Endothelial dysfunction is a key factor in microvascular complications of type 1 diabetes (T1D).
- The specific role of metabolic memory versus disease duration in early microvascular alterations in pediatric T1D remains unclear.
Purpose of the Study:
- To investigate the relationship between micro- and macrocirculation and metabolic memory stages in pediatric type 1 diabetes.
- To determine whether early poor glycemic control leads to lasting endothelial changes in T1D microcirculation.
- To compare the influence of disease duration and metabolic memory on vascular parameters in T1D youth.
Main Methods:
- Assessed microcirculation using capillaroscopy, transcutaneous oxygen pressure (TcPO2), and optical coherence tomography (OCT).
- Evaluated macrovascular circulation via pulsatility index (PI), ankle-brachial index (ABI), and pulse pressure (PP).
- Measured inflammatory markers (TNF-α, IL-35, IL-4, IL-10, IL-18, IL-12), angiogenin, VEGF, adhesion molecules (sVCAM-1, ICAM-1, sP-Selectin), AGEs, and sRAGE.
Main Results:
- Micro- and macrovascular parameters were similar between groups with different metabolic memory levels but comparable disease duration and age at diagnosis.
- Subgroups with identical metabolic memory but varying disease durations showed distinct vascular profiles.
- Shorter T1D duration correlated with higher capillary density, smaller inter-capillary distance, lower AGEs, a reduced TNF-α/IL-35 ratio, and higher levels of IL-35, IL-4, and IL-12.
Conclusions:
- Disease duration, rather than metabolic memory, is the primary driver of early microvascular alterations in pediatric type 1 diabetes.
- Early T1D duration is associated with favorable microcirculatory function and reduced inflammation.
- These findings highlight the critical importance of managing disease duration in preventing vascular complications in young T1D patients.
Abstract:
In the current study, we focus on analyzing the relationship between changes in micro- and macrocirculation and different stages of metabolic memory. We hypothesized that early poor glycemic control induces lasting endothelial changes detectable in pediatric type 1 diabetes (T1D) microcirculation. We assessed microcirculation structure and function using capillaroscopy, transcutaneous oxygen pressure (TcPO2), and optical coherence tomography (OCT). We evaluated macrovascular circulation using pulsatility index (PI), ankle-brachial index (ABI) and pulse pressure (PP). We also examined the relationship between circulation parameters, the age at onset, and diabetes duration. The study included 67 patients with uncomplicated type 1. We divided all patients into four groups based on their HbA1c levels at T1D onset and their average HbA1c after one and two years. We assessed the concentrations of TNF-α, IL-35, IL-4, IL-10, IL-18, IL-12, serum angiogenin, VEGF, sVCAM-1, ICAM-1, sP-Selectin, AGEs, and sRAGE. We compared subgroups with different levels of metabolic memory but comparable T1D duration and age at diagnosis. Micro- and macrovascular parameters were similar between the groups. Our comparison of subgroups with identical metabolic memory but different durations and ages at diagnosis revealed clear differences. The subgroup with a shorter T1D duration showed higher capillary density and a smaller inter-capillary distance compared to those with a longer diabetes duration. This subgroup with shorter duration had significantly lower AGE levels and a reduced TNF-α/IL-35 ratio, along with higher levels of IL-35, IL-4, and IL-12, compared to the longer-duration group. Our findings indicate that in youths with uncomplicated T1D, disease duration-not metabolic memory-plays a dominant role in early microvascular alterations.
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