Impact of type 1 diabetes mellitus on cardiac and vascular parameters in children: A case–control study

Background Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder associated with an increased risk of cardiovascular disease due to early vascular and myocardial dysfunction. Carotid intima-media thickness (cIMT) and myocardial performance index (MPI) are valuable noninvasive markers for detecting early cardiovascular abnormalities. This study aimed to assess the impact of T1DM on cIMT and MPI in children, evaluate the association between glycemic control and cardiovascular changes, and identify predictors of early cardiovascular risk. Methods This cross-sectional, case–control study included 160 children aged 6–18 years, comprising 80 T1DM patients (disease duration >5 years) and 80 age- and sex-matched healthy controls. Clinical and metabolic parameters, including glycated hemoglobin (HbA1c) and lipid profiles, were assessed. High-resolution Doppler ultrasonography was used to measure cIMT, while echocardiographic assessments included MPI, ejection fraction, tricuspid annular plane systolic excursion (TAPSE), and the diastolic filling velocity ratio ( E / e ′ ratio). Data were analyzed using independent t -tests, correlation analyses, and multivariate regression models. Results Children with T1DM exhibited significantly higher cIMT (0.49 [0.03] mm vs. 0.42 [0.04] mm, P < 0.001), with a higher prevalence of increased cIMT (35% vs. 8%, P < 0.001), indicating early vascular remodeling. Echocardiographic findings showed reduced TAPSE in T1DM patients (2.23 [0.12] cm vs. 2.12 [0.17] cm, P = 0.009), suggesting right ventricular dysfunction, and a significantly higher E / e ′ ratio ( P = 0.002), indicating diastolic impairment. Correlation analysis revealed a strong association between cIMT and HbA1c ( r = 0.56, P < 0.001), as well as positive correlations with age ( r = 0.36, P = 0.004), BMI ( r = 0.26, P = 0.04), and weight ( r = 0.31, P = 0.009). Multivariate regression identified HbA1c as the strongest predictor of cIMT ( β = 0.520, P < 0.001), followed by age, TAPSE, and systolic blood pressure. Conclusion Pediatric T1DM patients exhibit significant early vascular and cardiac changes, with increased cIMT serving as a marker of subclinical atherosclerosis. Poor glycemic control was the strongest predictor of vascular dysfunction. Subtle echocardiographic abnormalities suggest early myocardial impairment. These findings emphasize the need for routine cardiovascular screening in children with T1DM to enable early intervention and reduce long-term cardiovascular risk.