What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 1 Diabetes (n=299). Intervention: Sudomotor dysfunction (Feet ESC <70 µS) vs. Normal sudomotor function (Feet ESC ≥70 µS). Primary outcome: Carotid intima-media thickness (cIMT) in mm (p=0.04).

What does this research mean for the field?

Sudomotor dysfunction in adults with type 1 diabetes is associated with thicker carotid intima-media thickness (0.56 vs 0.54 mm, p = 0.04) and higher vascular age (48 vs 42 years, p = 0.04). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

Explore the connection between sudomotor function, carotid intima-media thickness, and vascular age in adults with type 1 diabetes.

January 18, 2026Open Access

Sudomotor dysfunction reflects early atherosclerosis risk in adults with type 1 diabetes

Q: What are the key findings of this study?

Sudomotor dysfunction was significantly associated with increased carotid intima-media thickness (0.56 vs 0.54 mm) and higher vascular age (48 vs 42 years) in adults with type 1 diabetes.

Q: What does this research mean for the field?

Sudomotor dysfunction in adults with type 1 diabetes is associated with thicker carotid intima-media thickness (0.56 vs 0.54 mm, p = 0.04) and higher vascular age (48 vs 42 years, p = 0.04). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Q: What question did this study set out to answer?

Explore the connection between sudomotor function, carotid intima-media thickness, and vascular age in adults with type 1 diabetes.

Key Result

Sudomotor dysfunction was significantly associated with increased carotid intima-media thickness (0.56 vs 0.54 mm) and higher vascular age (48 vs 42 years) in adults with type 1 diabetes.

Key Points

Explore the connection between sudomotor function, carotid intima-media thickness, and vascular age in adults with type 1 diabetes.
Cross-sectional analysis of 299 adults with type 1 diabetes.
SUDOSCAN was used to measure sudomotor function; carotid intima-media thickness was assessed via ultrasound.
Multiple linear regression adjusted for sex, HbA1c, BMI, and creatinine was performed.
Participants with sudomotor dysfunction had thicker carotid intima-media thickness (p = 0.04) and higher vascular age (p = 0.04).
A negative correlation between Feet ESC and cIMT was found (Rs = -0.22, p < 0.001).
Reduced Feet ESC showed a significant association with vascular age (β = 0.13, p = 0.03).

Study Design

Type

Cross-Sectional (n=299)

Multicenter

Structured PICO

Does sudomotor dysfunction correlate with increased carotid intima-media thickness and vascular age in adults with type 1 diabetes?

Population

299 adults with type 1 diabetes (T1D), aged 34 (IQR: 25-44) years, disease duration 16 (IQR: 11-25) years, and HbA1c of 7.7 (IQR: 7.0-8.7)%. Exclusion criteria: pregnancy, active foot ulceration or limb amputation, ketoacidosis, acute infection, implanted electronic devices, mental and neurological disorder, and diagnosed CVD.

Intervention

Sudomotor dysfunction (SMD) defined as Feet electrochemical skin conductance (ESC) < 70 µS measured with the SUDOSCAN device

Comparator

Preserved sudomotor function (Feet ESC ≥ 70 µS)

Outcome

Carotid intima-media thickness (cIMT) and vascular age (VA)surrogate

Sudomotor dysfunction is associated with increased carotid intima-media thickness and vascular age in adults with type 1 diabetes, suggesting it may serve as an early, non-invasive marker of subclinical atherosclerosis.

Main Result

Absolute Event Rate: 0.56% vs 0.54%

p-value: p=0.04

Limitations

No a priori sample size calculation
Cross-sectional design does not allow for causal inference
Only indirect markers were assessed without confirmation by skin biopsy or neurophysiological testing
Lack of standardization across various definitions of cIMT
Multicollinearity between age, diabetes duration, hypertension, and electrochemical skin conductance

Abstract

Abstract Adults with type 1 diabetes (T1D) are at increased risk of premature atherosclerosis. Sudomotor dysfunction (SMD), an early manifestation of diabetic neuropathy, may contribute to vascular injury. This cross-sectional study assessed the relationship between sudomotor function (SMF), carotid intima-media thickness (cIMT), and vascular age (VA) in T1D. The study included 299 adults with T1D (137 men), aged 34 (IQR: 25–44) years, disease duration 16 (IQR: 11–25) years, and HbA1c of 7.7 (IQR: 7.0–8.7)%. Sudomotor function was measured with the SUDOSCAN device; abnormal function was defined as Feet ESC < 70 µS (SMD). cIMT was assessed with carotid ultrasound, and VA was derived from cIMT values. Participants with SMD had thicker cIMT 0.56 (IQR: 0.5–0.67) vs 0.54 (0.48–0.52), p = 0.04 and higher VA 48 (36–70) vs 42 (32–58), p = 0.04. We found a negative correlation between Feet ESC and cIMT (Rs = − 0.22, p < 0.001). In a multiple linear regression model adjusted for sex, HbA1c, BMI, and creatinine, reduced Feet ESC remained significantly associated with VA (β = 0.13, p = 0.03), R 2 = 0.065. SMD is associated with increased cIMT and VA in adults with T1D. SMF assessment by SUDOSCAN may represent a rapid, non-invasive tool to identify individuals at higher cardiovascular risk.

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