Prevalence of Increased Arterial Stiffness in Children with Type 1 Diabetes Mellitus Differs by Measurement Site and Sex: The SEARCH for Diabetes in Youth Study

Urbina, Elaine M.; Wadwa, R. Paul; Davis, Cralen; Snively, Beverly M.; Dolan, Lawrence M.; Daniels, Stephen R.; Hamman, Richard F.; Dabelea, Dana

doi:10.1016/j.jpeds.2009.11.011

« Previous Next »The Journal of Pediatrics
Volume 156, Issue 5 , Pages 731-737.e1, May 2010

Prevalence of Increased Arterial Stiffness in Children with Type 1 Diabetes Mellitus Differs by Measurement Site and Sex: The SEARCH for Diabetes in Youth Study

Elaine M. Urbina, MD
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
R. Paul Wadwa, MD
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
Cralen Davis, BS, MS
- Division of Public Health Services, Wake Forest University Health Sciences, Winston-Salem, NC
Beverly M. Snively, PhD
- Division of Public Health Services, Wake Forest University Health Sciences, Winston-Salem, NC
Lawrence M. Dolan, MD
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
Stephen R. Daniels, MD, PhD
- Department of Pediatrics, University of Colorado School of Medicine, The Children's Hospital, Aurora, CO
Richard F. Hamman, MD, DrPH
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
Dana Dabelea, MD, PhD
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO

Received 17 March 2009; received in revised form 1 October 2009; accepted 9 November 2009. published online 25 January 2010.

Objective

To discuss vascular stiffness commonly encountered in children with type 1 diabetes mellitus (T1DM).

Study design

We examined 535 subjects with T1DM (14.6 years; 53% male, 88% non-Hispanic white) and 241 healthy control subjects (17.8 years; 42% male, 39% non-Hispanic white). Abnormalities in brachial distensibility (BrachD), pulse wave velocity, and augmentation index corrected to a HR of 75 (AIx-75) were examined.

Results

Subjects with T1DM had higher body mass index, LDL-cholesterol, fasting glucose, and blood pressure than control subjects. Diabetic subjects had lower BrachD and higher AIx-75 indicating increased stiffness. Age-adjusted pulse wave velocity–trunk (aorto-femoral) was higher in cases (all P ≤ < .05). Increased peripheral stiffness was more common than central stiffness in subjects with T1DM (low BrachD in 33% vs high PWV-trunk in 9.9%). Male subjects with type 1 diabetes had a higher prevalence of VS abnormalities than females. Presence of T1DM, male sex, and increased mean arterial pressure were the most consistent independent determinants of vascular stiffness.

Conclusions

Increased vascular stiffness is present in youth with T1DM with peripheral abnormalities predominating especially in males. Traditional risk factors are important correlates. Identifying early vascular abnormalities in youth with T1DM will allow for implementation of more aggressive risk factor management.

AIx, Augmentation index, AIx-75, Augmentation index normalized to HR of 75 beats/min, BMI, Body mass index, BrachD, Brachial artery distensibility, CV, Cardiovascular, DBP, Diastolic blood pressure, T1DM, Type 1 diabetes mellitus, HbA1c, Glycosylated hemoglobin A1c, HDL-C, HDL-cholesterol, HR, Heart rate, LDL-C, LDL-cholesterol, MAP, Mean arterial blood pressure, PWV, Pulse wave velocity, PWV-arm, PWV from carotid to radial artery, PWV-leg, PWV from femoral to dorsalis pedis artery, PWV-trunk, PWV from carotid to femoral artery, SBP, Systolic blood pressure, VS, Vascular stiffness