Adult-like but regressive increase of intima-media thickness and roughness in a child with type 1 diabetes

Abstract

A 12-yr-old Kosovo-Albanian boy with insufficiently controlled type 1 diabetes since his second year of life developed severely increased intima-media thickness (IMT) and roughness (IMR) of the common carotid artery (CCA): max/mean IMT=0.81/0.68 mm and IMR=0.048 mm. Intima-media thickening, comparable with that in a 50- to 60-yr-old healthy adult, decreased within 41 months (max/mean carotid IMT=0.72/0.56 mm and IMR=0.036 mm) by intensive treatment of diabetes. Moyamoya disease (MMD), complicated by cerebral infarction, occurred coincidentally but regressed within 6 months. This case report points out that (i) chronic hyperglycemia in childhood may lead to adult-like increase of carotid IMT/IMR as early signs of subclinical atherosclerosis, (ii) increased carotid IMT/IMR may be regressive by intensive diabetes control, and (iii) a screening examination for carotid IMT/IMR should be considered in patients at high risk of atherosclerosis.

Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia

“…In our study, diabetes duration significantly correlated with cIMT both in the multiple regression analysis and in the Spearman rank correlations. In a 12-year-old boy with T1DM we also could show that significant improvement of a long-term poor diabetic control may lead to considerable decrease of the mean cIMT from 0.68 mm to 0.56 mm showing that increased cIMT in diabetic children can be regressive by intensive treatment [21].…”

Beyond intima-media-thickness: Analysis of the carotid intima-media-roughness in a paediatric population

“…In the paediatric age group, structural analysis of the carotid wall has been performed in a case study [16]. When this patient presented with a poorly controlled diabetes mellitus type 1, cIMR was found to be 0.048 mm, a value comparable to adult patients.…”

“…Moreover, availability of normative data for cIMR in a paediatric age group may enhance the power of vascular ultrasound and related measurements to predict future cardiovascular events early in adulthood in selected patient groups with elevated cardiovascular risk [15]. So far, structural analysis of the carotid arterial wall has not been performed in children except for one single case study [16]. Thus, normative data on cIMR are lacking for the paediatric population.…”

Carotid artery intima-media thickness in pediatric type 1 diabetic patients

“…In adult diabetic patients, the IMT has responded to optimized metabolic control of the disease, resulting in slower IMT progression over the years (38). In children, a case report about the regression of a formerly increased IMT in a boy receiving intensified insulin therapy may be indicative for similar effects (39). So, longitudinal IMT measurements may offer a reliable tool for the calculation of the cardiovascular risk status of the patients and may be used for the monitoring of therapeutic effects.…”