Age of Onset of Type 1 Diabetes in Children and Carotid Intima Medial Thickness

Abstract

CONTEXT: Cardiovascular disease due to atherosclerosis is a major cause of morbidity and mortality in adult diabetic patients. In children, signs of subclinical atherosclerosis such as increased intima-media thickness (IMT) of the common carotid arteries have been detected in several studies. However, concerns may arise about the different analyzing methods used because measurements in patients and controls differ significantly. PATIENTS AND METHODS: We studied 208 children [150 patients with diabetes mellitus type 1, mean age (+/-sd) 13.9 +/- 2.8 yr, 66 males, mean glycosylated hemoglobin (+/-sd) 7.8 +/- 1.4%, and 58 healthy controls, mean age (+/-sd) 14.1 +/- 3.1 yr, 32 males] and used normal IMT values published recently for comparison of the results. RESULTS: Of 150 patients, 37 had an increased IMT [mean IMT (+/-sd) 1.6 +/- 0.6], whereas healthy controls had nearly normal IMT values [mean IMT (+/-sd) 0.3 +/- 0.1; P < 0.001]. Age at onset of diabetes, mean daily insulin dosage, systolic blood pressure, and total cholesterol level were significantly related to IMT in a multilinear regression model. A total of 25 diabetic patients were hypertensive and had a significantly increased IMT (mean IMT 0.475 +/- 0.03 mm) compared to the remaining patients (mean IMT 0.459 +/- 0.02 mm; P < 0.05). CONCLUSIONS: The IMT measurement detected subclinical atherosclerosis in a large cohort of diabetic children. Systolic blood pressure, total cholesterol level, insulin dosage, and age at onset of the disease were significantly related to the IMT. Longitudinal measurements may help to identify patients at special risk for atherosclerotic changes and cardiovascular disease.