Evaluation of Carotis Intima Media Thickness and Cardiac Functions in Children with Type 1 Diabetes Mellitus

Year 2022, Volume: 6 Issue: 3, 260 - 266, 29.12.2022

Veli Akkurt , Mehmet Fatih Deveci , Osman Başpınar , Mehmet Keskin

https://doi.org/10.25048/tudod.1152686

Abstract

Aim: To evaluate carotid intima-media thickness (CIMT), left cardiac systolic and diastolic functions by echocardiographic method in children followed up with the diagnosis of Type 1 Diabetes Mellitus (DM).
Material and Methods: Thirty-one patients with type 1 DM who were followed up at our university for at least 4 years and 19 healthy children as the control group were included in the study. Patients were grouped according to; glycemic control level, duration of illness, gender and compared with the control group. Statistical analyzes were performed using the SPSS for Windows version 17.0 package
program.
Results: The patient and control groups were similar in terms of age, height, gender, weight, body mass index, systolic and diastolic blood pressure (p>0.05). There was no significant difference between diabetic patients and control group, cardiac systolic and diastolic functions, CIMT values (p>0.05). When the patients were divided into subgroups according to diabetes duration and glycemic control;no significant difference was found between CIMT levels (respectively, p=0.084 and p=0.410). In patients with DM duration ≥8 years, CIMT was found to be 0.54 mm, although it was not statistically significant, it was found to be significantly increased. In the subgroup analysis, left CIMT was found to be significantly increased in diabetic boys compared to control boys and diabetic girls (respectively, p=0.026 and p=0.022). A significant difference was found in the mean CIMT in diabetic boys compared to the diabetic girls group (p=0.042).
Conclusion: Increased mean and left CIMT in diabetic men suggested that gender might be an independent risk factor for atherosclerosis. Despite intensive diabetes treatment and glycemic control, Type 1 DM is an important risk factor affecting the cardiovascular system, especially in male gender, even in childhood.

Keywords

Type 1 diabetes mellitus, carotid intima media thickness, cardiac functions, childhood

Tip 1 Diyabetli Çocuklarda Kardiyak Fonksiyonlar ile Karotis İntima Media Kalınlığının Değerlendirilmesi

Abstract

Amaç: Tip 1 Diyabetes Mellitus (DM) tanısı ile izlenen çocuklarda, karotis intima media kalınlığı (KİMK), sol kardiyak sistolik ve diyastolik fonksiyonları ekokardiyografik yöntem ile değerlendirmek.
Gereç ve Yöntemler: Üniversitemizde en az 4 yıldır tip 1 DM tanısı ile izlenen 31 hasta ve kontrol grubu olarak 19 sağlıklı çocuk çalışmaya alınmıştır. Hastalar; glisemik kontrol düzeyleri, hastalık süreleri ve cinsiyetlerine göre gruplandırılarak, kontrol grubuyla karşılaştırıldı. SPSS for Windows version 17.0 paket programı kullanılarak istatistiksel analizler yapıldı.
Bulgular: Hasta ve kontrol grubu; yaş, boy, cinsiyet, ağırlık, vücut kütle indeksi, sistolik ve diyastolik kan basıncı bakımından benzerdi (p>0.05). Diyabetli hastalar ve kontrol grubu, kardiyak sistolik ve diyastolik fonksiyonlar, KİMK değerleri arasında anlamlı bir fark yoktu (p>0.05). Hastalar diyabet sürelerine göre ve glisemik kontrole göre alt gruplara ayrıldığında KİMK düzeyleri arasında anlamlı bir fark bulunamadı (sırasıyla, p=0.084 ve p=0.410). DM süresi ≥8 yıl olan hastalarda KİMK 0.54 mm olarak istatistiksel anlamlı olmasa da belirgin artmış olarak bulundu. Alt grup analizinde diyabetik erkeklerde, kontrol grubu erkeklere ve diyabetik kızlara göre sol KİMK anlamlı olarak artmış olarak bulundu (sırasıyla, p=0.026 ve p=0.022). Diyabetik erkeklerde ortalama KİMK kız grubuna göre anlamlı fark saptandı (p=0.042).
Sonuç: Diyabetik erkeklerde artış gösteren ortalama ve sol KİMK, ateroskleroz açısından cinsiyetin bağımsız bir risk faktörü olabileceğini düşündürdü. Yoğun diyabet tedavisi ve glisemik kontrolüne rağmen Tip 1 DM özellikle erkek cinsiyette çocukluk çağında dahi kardiyovasküler sistemi etkileyen önemli bir risk faktörüdür.

Keywords

Tip 1 diyabetes mellitus, karotis intima media kalınlığı, kardiyak fonksiyonlar, çocukluk çağı

References

• Referans1. Gow ML, Varley BJ, Nasir RF, Skilton MR, Craig ME. Aortic intima media thickness in children and adolescents with type 1 diabetes: a systemic review. Pediatr Diabetes. 2022;23:489-498.
• Referans2. Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman WP 3rd, Cornhill JF. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA. 1999;281:727-735.
• Referans3. Lamotte C, Iliescu C, Libersa C, Gottrand F. Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies. Eur J Pediatr. 2011;170:719-729.
• Referans4. Torkar AD, Plesnik E, Groselj U, Battelino T, Kotnik P. Carotid intima-media thickness in healthy children and adolescents: normative data and systemic literature review. Front Cardiovasc Med. 2020;7:597768.
• Referans5. Wong M, Edelstein J, Wollman J, Bond MG. Ultrasonic-pathological comparison of the human arterial wall. Verification of intima-media thickness. Arterioscler Thromb. 1993;13:482-486.
• Referans6. Grobbee DE, Bots ML. Carotid artery intima-media thickness as an indicator of generalized atherosclerosis. J Intern Med. 1994;236:567-573.
• Referans7. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338:1650-1656.
• Referans8. Woo KS, Chook P, Yu CW, Sung RYT, Qiao M, Leung SSF, Lam CWK, Metreweli C, Celermajer DS. Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening. Int J Obes Relat Metab Disord. 2004;28:852-857.
• Referans9. Crouse JR 3rd, Craven TE, Hagaman AP, Bond MG. Association of coronary disease with segment-specific intimal-medial thickening of the extracranial carotid artery. Circulation. 1995;92:1141-1147.
• Referans10. Maya L, Villarreal FJ. Diagnostic approaches for diabetic cardiomyophaty and myocardial fibrosis. J Mol Cell Cardiol. 2010;48:524-529.
• Referans11. Raev DC. Which left ventricular function is impaired earlier in the evolution of diabetic cardiomyopathy? An echocardiographic study of young type 1 diabetic patients. Diabetes Care. 1994;17:633-639.
• Referans12. Al-Biltagi MA, Tolba OA, Mawlana W, Abd El Hamed A, Ghazy M. Resistin and right ventricular function in children with recently diagnosed type-1 diabetes mellitus: a case control study. J Pediatr Endocrinol Metab. 2015;28:299-308.
• Referans13. Orem C, Kucukosmanoglu M, Hacihasanoglu A, Yılmaz R, Kasap H, Erdogan T, Kaplan S, Celik Sukru. Association of Doppler-derived myocardial performance index with albuminuria in patients with diabetes. J Am Soc Echocardiogr. 2004;17:1185-1190.
• Referans14. Erdogan D, Akcay S, Ersoy IH, Icli A, Yucel H, Kutlucan A, Arslan A, Ozaydin M, Tamer MN. Cardiac determinants of impaired exercise performance in patients with type 2 diabetes mellitus. Int J Cardiol. 2011;152:143-146.
• Referans15. Bernard S, Serusclat A, Targe F, Charriere S, Roth O, Beaune J, BerthezeneF, Moulin P. Incremental predictive value of carotid ultrasonography in the assessment of coronary risk in a cohort of asymptomatic type 2 diabetic subjects. Diabetes Care. 2005;28:1158-1162.
• Referans16. Baldassarre D, Amato M, Bondioli A, Sirtori CR, Tremoli E. Carotid artery intima-media thickness measured by ultrasonography in normal clinical practice correlates well with atherosclerosis risk factors. Stroke. 2000;31:2426-2430.
• Referans17. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115:459-467.
• Referans18. Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Epidemiology of Diabetes Interventions and Complications (EDIC). Design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort. Diabetes Care. 1999;22:99-111.
• Referans19. Tell GS, Howard G, McKinney WM. Risk factors for site specific extracranial carotid artery plaque distribution as measured by B-mode ultrasound. J Clin Epidemiol. 1989; 42:551-559.
• Referans20. Giannopoulou EZ, Doundoulakis I, Antza C, Christoforidis A, Haidich AB, Kotsis V, Stabouli S. Subclinical arterial damage in children and adolescents with type 1 diabetes: a systemic review and meta-analysis. Pediatric Diabetes. 2019;20:668-677.
• Referans21. Shivalkar B, Dhondt D, Goovaerts I, Gaal LV, Bartunek J, Crombrugge PV, Vrints C et. Flow mediated dilatation and cardiac function in type 1 diabetes mellitus. Am J Cardiol. 2006;97:77-82.
• Referans22. Belhassen L, Carville C, Pelle G, Monin JL, Teiger E, Duval-Moulin AM, Dupouy P, Rande JLD, Gueret P. Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery. J Am Coll Cardiol. 2002;7:1139-1144.
• Referans23. Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal medial thickness and coronary calcification are related in young and middle-aged adults. The Muscatine study. Circulation. 1999;100:838-842.
• Referans24. Held C, Hjemdahl P, Eriksson SV, Björkander I, Forslund L, Rehnqvist N. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J. 2001;22:62-72.