Key result
In children and adolescents with type 1 diabetes, lower time-in-range was independently associated with higher arterial stiffness (standardized β -0.15; 95% CI -0.26 to -0.03; p<0.011).
Why the study?
To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in children and adolescents with type 1 diabetes in a modern European technology-based setting.
Cross-Sectional (n=127)
Yes
Effect estimate: standardized β -0.15 (95% CI -0.26 to -0.03)
p-value: p=< 0.011
In children and adolescents with type 1 diabetes, elevated arterial stiffness is prevalent and independently associated with older age and lower time-in-range, highlighting the importance of glycemic control beyond HbA1c.
Elevated arterial stiffness persists despite modern T1D care; leaves open whether TIR optimization alters progression in youth.
Objective: To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology‐based cohort of children and adolescents with type 1 diabetes. Research Design and Methods: Cross‐sectional study, including 127 children recruited from Pediatric Diabetes Departments across Eastern Denmark between May 2022 and January 2024. Arterial stiffness was assessed as carotid–femoral pulse‐wave‐velocity (cfPWV) using the Sphygmocor XCEL system. Unadjusted and adjusted linear regression models explored associations between cfPWV and other risk factors. Adjustments included age, sex, diabetes duration, time‐in‐range, hemoglobin A1c (HbA1c), body mass index (BMI) z ‐score, low‐density lipoprotein (LDL)‐cholesterol, and mean arterial pressure (MAP). Results: Median (interquartile range [IQR]) age was 14.2 years (12.0, 16.4), diabetes duration was 4.7 years (2.7, 8.4), HbA1c level was 7.0% (6.5, 7.9), (53 mmol/l: 48–63), time‐in‐range was 63% (53–75), and 52% were male. The majority were treated with continuous‐subcutaneous‐insulin‐infusion (82%), and all (except two) used continuous‐glucose‐monitors. The prevalence of elevated arterial stiffness (cfPWV z ‐score over the 90th percentile) was 16%. Unadjusted analyses demonstrated higher cfPWV was associated with longer diabetes duration, higher age, HbA1c, MAP, and liver stiffness, and lower time‐in‐range and insulin sensitivity. Higher cfPWV remained associated with higher age (standardized β (confidence interval (CI) 95%): 0.38 (0.27, 0.48); p < 0.001) and lower time‐in‐range (−0.15 ((−0.26), (−0.03)); p < 0.011) after adjustment. Conclusions: Despite modern treatment technology and better overall metabolic control, children and adolescents with type 1 diabetes present with a high prevalence of elevated arterial stiffness. Higher arterial stiffness was associated with higher age and lower time‐in‐range, independent of other risk factors, including HbA1c.
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Damm et al. (2024) conducted a cross-sectional in type 1 diabetes (n=127). Time-in-range was evaluated on carotid-femoral pulse-wave-velocity (cfPWV) (standardized β -0.15, 95% CI -0.26 to -0.03, p=< 0.011). In children and adolescents with type 1 diabetes, lower time-in-range was independently associated with higher arterial stiffness (standardized β -0.15; 95% CI -0.26 to -0.03; p<0.011).
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