What is the clinical evidence from this study?

Study design: Observational. Population: Type 1 diabetes mellitus (n=70). Intervention: Observation vs. Baseline. Primary outcome: Mean carotid intima media thickness (cIMT) z-score (p=<0.001).

June 16, 2011Open Access

The effect of cardiovascular risk factors on the longitudinal evolution of the carotid intima medial thickness in children with type 1 diabetes mellitus

Q: What are the key findings of this study?

In children and adolescents with type 1 diabetes mellitus, mean carotid intima media thickness z-scores increased significantly by 0.58 over 4 years, with systolic blood pressure and BMI as significant predictors of progression.

RPRobert Dalla PozzaLudwig-Maximilians-Universität München ABAndreas BeyerleinHealth and Safety Authority CTClaude ThilmanyLudwig-Maximilians-Universität München

Key Result

In children and adolescents with type 1 diabetes mellitus, mean carotid intima media thickness z-scores increased significantly by 0.58 over 4 years, with systolic blood pressure and BMI as significant predictors of progression.

Study Design

Type

Observational (n=70)

Blinding

Single-blind

Multicenter

Structured PICO

Population

70 children and adolescents with type 1 diabetes mellitus (T1DM), mean age 16.45±2.59 years at re-evaluation, 38 female.

Outcome

Changes in carotid intima media thickness (cIMT) z-scores over 4 yearssurrogate

In children and adolescents with type 1 diabetes, subclinical atherosclerosis progresses over time, and this progression is significantly associated with modifiable risk factors like systolic blood pressure and BMI.

Main Result

Absolute Event Rate: 2.44% vs 1.86%

p-value: p=<0.001

Limitations

Observational study design cannot establish causality
Significant loss-to-follow-up of 80 patients from the initial cohort
Measurement method differs from some other research groups

Abstract

BACKGROUND: Type 1 diabetes mellitus is a generally accepted atherogenic risk factor. The aim of this prospective longitudinal study was to evaluate changes in carotid intima media thickness (cIMT) in children and adolescents with type 1 diabetes mellitus (T1DM) using standardized methods. METHODS: We re-evaluated cIMT in 70 (38 f) of initial 150 (80 f) patients with T1DM after 4 years. At re-evaluation, mean (±SD) age was 16.45±2.59 y, mean diabetes duration was 9.2±3.24 y and patients had a mean HbA1c of 8.14±1.06%. RESULTS: Mean cIMT z-scores increased significantly during 4 years (0.58±0.75, p<0.001) as well as BMI-z-score (0.41±0.81, p<0.01), systolic blood pressure (0.77±1.15, p<0.01) and HbA1c (0.90±1.07, <0.001). In a linear regression model systolic blood pressure z-score at first measurement (0.02, CI: 0.01, 0.04) was a significant predictor for the mean effect on cIMT z-score. In a logistic regression model significant risk factors for an increase in IMT of ≥1.5 z-scores were BMI z-scores (OR: 3.02, CI:1.11, 10.14), diabetes duration (OR:1.32, CI:1.04, 1.77) and systolic blood pressure (OR: 1.14, CI: 1.04, 1.27) at first measurement each. CONCLUSIONS: Longitudinal cIMT measurements revealed progression in subclinical atherosclerosis during a four year period in diabetic children and adolescents. Systolic blood pressure and BMI were related to cIMT increment. Control of these risk factors by lifestyle and medical intervention may prevent progression of cIMT in diabetic children.

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