Early Endothelial Dysfunction in Young Type 1 Diabetics

Objectives: Endothelial dysfunction is a known precursor of atherosclerosis and can be assessed by measuring the brachial. artery flow-mediated dilatation (FMD) via ultrasonography. This study investigated endothelial function in young type 1 diabetics without cardiovascular morbidity or diabetes-related pathology. Methods: Young diabetics and healthy controls were recruited, both meeting strict inclusion and exclusion criteria. To prove absence of subclinical atherosclerosis, intima-media thickness (IMT) measurements at the carotid bifurcation were done in all of them. FMD was measured at the brachial artery. The results were compared using the t-test and the influences of different variables on FMD were assessed using multiple linear regression. Results: Twenty-six diabetics (23.4 +/- 5.8 years) and 36 healthy volunteers (23.1 +/- 2.8 years) were recruited. The duration of diabetes was 9.2 +/- 5.3 years; metabolic control was moderate (HbA1c 7.6 +/- 1.0%) and IMT was normal in both groups. FMD was significantly impaired in type 1 diabetics (7.13 +/- 0.43 vs. 8.77 +/- 0.43%; p = 0.002). The FMD grade was associated with diabetes and age. Patients with a good metabolic control (HbA1c <= 7.0%) had a better FMD. Conclusions: In type 1 diabetics, even without preclinical or clinical atherosclerosis, endothelial function is already disturbed and can be detected using ultrasonography. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.