Uncontrolled type-1 diabetes (T1DM) can lead to dyslipidaemia and albuminuria, which may promote cardiovascular injuries. However, some lipidemic factors could be useful in predicting cardiac dysfunction. Seventy-eight adolescents under insulin treatment due to a 6-year history of T1DM and were retrospectively examined. Glycemia, lipidemia, and albuminuria were measured in addition to development of cardiovascular abnormalities Both girls and boys showed higher HbA1c and fasting blood glucose and 27.1% females and 33.3% males exhibited microalbuminuria though their plasma levels of total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL) and high-density lipoproteins (HDL lipoproteins were in the normal range. They exhibited a preserved systolic function, but 50% of females and 66.6% of males had developed diastolic failures. Interestingly, girls with diastolic dysfunction showed significantly lower concentrations of HDL and higher TC/HDL and TG/HDL ratios. In fact, low HDL levels (OR 0.93; 95% CI 0.88–0.99; p = 0.029) and high TC/HDL (OR 2.55; 95% CI 1.9–5.45; p = 0.016) and TG/HDL (OR 2.74; 95% CI 1.12–6.71; p = 0.028) ratios associated with the development of diastolic complications. The cut-off values for HDL, TC/HDL, and TG/HDL were 49 mg/dL, 3.0 and 1.85, respectively. HDL and TC/HDL and TG/HDL ratios may be useful for predicting diastolic dysfunction in girls with uncontrolled T1DM.

Purpose: Early detection of diabetic retinopathy can prevent progressive visual loss. Evaluate the role of Optical Coherence Tomography Angiography (OCTA) in early detection of diabetic retinopathy (DR) in type 1 diabetes (T1D) adolescents with normal fundus photography. Methods: Cross-sectional study included 150 eyes of 75 T1D adolescents from the Diabetes Endocrine and Metabolism Pediatric Unit, Children hospital, Cairo University. Their ages ranged from 10-18 years and diabetes duration 2 years or more. Fundus photography, OCT and OCTA were done in the diagnostic and laser unit, Ophthalmology department. Results: Twenty-eight patients (37.3%) had abnormalities in the OCTA despite normal fundus examination, photography and OCT. Diabetes duration, DKA at presentation and frequency, elevated blood pressure, limited joint mobility, elevated HbA1c and dyslipidemia had a negative correlation with OCTA measurements (foveal, parafoveal and perifoveal densities). Patients with abnormal OCTA had significantly higher mean age, higher DKA frequency, and lower height SDS (p=0.034, 0.011 and 0.001 respectively). Univariate and multivariate analysis revealed age and DKA at diabetes presentation are significant predictors for abnormal OCTA. Conclusion: OCTA can be used in early detection of diabetic retinopathy in T1D adolescents especially with risk factors (Elevated HbA1c, frequent DKA, decreased height SDS and limited joint mobility).

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IntroductionDiabetic cardiomyopathy (DCM) is a serious complication that frequently occurs in patients with type 1 diabetes (T1D) necessitating early diagnosis. The aim of the current study was to detect subclinical DCM in Egyptian children and adolescents with T1D and evaluate the effect of antioxidants on myocardial dysfunction.Material and methodsThe current prospective observational cohort study included 81 T1D patients (9-20 years old) with diabetes duration > 4 years compared to 50 age and sex matched non-diabetic controls. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was assessed in addition to conventional echocardiography, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). Patients with myocardial dysfunction were supplemented with vitamin E (α-tocopherol) as an antioxidant for 1 year, then follow up echocardiography was done.ResultsNT-proBNP was elevated in 73 (90.1%) patients, 50.6% had left ventricular (LV) diastolic dysfunction, 14.8% had right ventricular (RV) diastolic dysfunction, 84% had LV systolic dysfunction and 91.4% had RV systolic dysfunction with statistically significant difference compared to controls. There was a significant negative correlation between LV global longitudinal strain (GLS) and NT-proBNP (p<0.001, r=-0.796). ROC curve analysis showed that NT-proBNP at a cut-off point ≥ 195 ng/ml detected LV systolic dysfunction function with 89.7% sensitivity and 84.6% specificity. Follow up after one year of α-tocopherol supplementation revealed significant improvement in LV systolic and diastolic functions as well as RV systolic dysfunction.ConclusionsNT-proBNP and non-conventional echocardiography were useful in early detection of subclinical cardiomyopathy in patients with T1D. Antioxidant treatment improved subclinical myocardial dysfunction in T1D patients.