Magnetic resonance imaging measures of decreased aortic strain and distensibility are proportionate to insulin resistance in adolescents with type 1 diabetes mellitus

Pediatr Diabetes. 2015 Mar;16(2):90-7. doi: 10.1111/pedi.12241. Epub 2014 Dec 18.

Abstract

Objectives: To determine whether children with type 1 diabetes mellitus (T1DM) have evidence of increased aortic stiffness or early atherosclerosis as measured by magnetic resonance imaging (MRI).

Background: T1DM increases risk for cardiovascular disease in adults but whether this process starts in childhood is unknown.

Subjects: A total of 54 T1DM patients (15.4 ± 2.6 yr) and 30 age-matched controls (14.8 ± 2.7 yr) participated.

Methods: MRI was performed to assess aortic arch pulse wave velocity (PWV), strain, and distensibility of the ascending and descending thoracic aorta and measures of atherosclerosis.

Results: Groups were well-matched for age, pulse pressure, and gender. Low-density lipoprotein-cholesterol (LDL-C) was higher in T1DM (119.3 ± 50 vs. 76.1 ± 13.5 mg/dL, p < 0.0001). There was a trend toward decreased strain and distensibility in T1DM vs. controls in the ascending (distensibility: T1DM 62.2 ± 19.9 kPa⁻¹ × 10⁻³, control 71.6 ± 26.4 kPa⁻¹ × 10⁻³, p = 0.08) and descending aorta (strain: T1DM 25.8 ± 6.2% vs. control 28.3 ± 6.8%, p = 0.09). There was no difference in arch PWV. Advancing age and male gender was negatively associated with aortic stiffness. Hemoglobin A1c (HbA1c) was inversely related to descending aorta strain and distensibility (p < 0.05). Children with diabetes in the lowest two tertiles of insulin sensitivity demonstrated thoracic descending aortas with significantly lower strain (p = 0.027) and distensibility (p = 0.039) and increased measures of wall irregularity (p = 0.005). There were no differences in measurements of atherosclerosis between the two groups.

Conclusions: Adolescents with T1DM, especially those with lower insulin sensitivity, demonstrated a trend toward stiffer, less compliant thoracic aortas, which was inversely associated with diabetes control. These data suggest large vessel aortopathy starts early in T1DM.

Trial registration: ClinicalTrials.gov NCT01236365.

Keywords: adolescents; cardiovascular diseases; insulin resistance; magnetic resonance imaging; type 1 diabetes mellitus.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Aorta, Thoracic
  • Aortic Diseases / complications*
  • Aortic Diseases / diagnosis
  • Aortic Diseases / epidemiology
  • Aortic Diseases / metabolism
  • Atherosclerosis / complications*
  • Atherosclerosis / diagnosis
  • Atherosclerosis / epidemiology
  • Atherosclerosis / metabolism
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / diagnosis*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / metabolism
  • Early Diagnosis
  • Feasibility Studies
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Insulin Resistance*
  • Magnetic Resonance Angiography
  • Male
  • Pilot Projects
  • Pulse Wave Analysis
  • Risk Factors
  • Sex Factors
  • United States / epidemiology
  • Vascular Stiffness*

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Associated data

  • ClinicalTrials.gov/NCT01236365