Female Children and Adolescents With Type 1 Diabetes Have More Pronounced Early Echocardiographic Signs of Diabetic Cardiomyopathy

Abstract

OBJECTIVE -This study was designed to assess whether children and adolescents with type 1 diabetes have early echocardiographic signs of subclinical cardiac dysfunction and whether sex, state of metabolic control, and diabetes duration are of influence.RESEARCH DESIGN AND METHODS -Systolic and diastolic blood pressure in supine and upright positions and echocardiographic parameters, including tissue Doppler measurements of the septal mitral annulus, were evaluated in 80 children and adolescents with stable type 1 diabetes and 52 age-and sex-matched control subjects. A possible correlation was examined for age, sex, HbA 1c , and diabetes duration with univariate and multivariate regression analysis. 58 Ϯ 8 ms) compared with female control subjects, suggesting delayed myocardial relaxation. Male diabetic patients only differed significantly from their control subjects for IVRT (66 Ϯ 9 vs. 59 Ϯ 8 ms). The measured parameters showed an expected correlation with age and BMI standard deviation scores in the control group. This correlation was significantly weaker in the diabetic population; only a weak influence was found for diabetes duration and glycosylated hemoglobin levels. RESULTSCONCLUSIONS -Young diabetic patients already have significant changes in left ventricular dimensions and myocardial relaxation, with the girls clearly being more affected. Tissue Doppler proved to have additional value in the evaluation of ventricular filling in this population. Almost no correlation was found for diabetes duration and HbA 1c with the cardiovascular changes. Diabetes Care 27:1947-1953, 2004S everal studies have established diabetes as a strong risk factor for cardiovascular morbidity and mortality, especially in women (1-4). This increased risk cannot be explained only by the high prevalence of comorbidity, such as coronary heart disease or arterial hypertension in diabetes (5). Therefore, the existence of a "diabetic" cardiomyopathy distinct from ischemic heart disease has been suggested to cause systolic or diastolic dysfunction (1,6,7). Considerable debate exists regarding the exact nature and cause of this cardiac dysfunction (8 -11). The autonomic nervous system dysfunction explains the frequently reported higher heart rate in diabetic patients compared with normal subjects and may result in changed cardiac dynamics (12,13). We previously reported that corrected QT prolongation and an increased QT dispersion are already present in children with diabetes (14), and these abnormalities have been linked to an increased mortality rate in adults (15). Adult diabetic patients without clinical heart failure are reported to have hypertrophic and noncompliant left ventricles, causing essentially diastolic dysfunction (16 -20). The association between these findings and metabolic control or diabetes duration is controversial (21,22). The aim of this study was to determine whether echocardiographic signs of diastolic or systolic dysfunction are already present in diabetic children and adolescents, a population in whom comorbid...

Exercise Training Improves but Does Not Normalize Left Ventricular Systolic and Diastolic Function in Adolescents With Type 1 Diabetes

“…Training was progressively adjusted to achieve 85% of the participant's maximal heart rate (obtained during the VO 2peak test) during aerobic exercise training (weeks 1-4). After that (weeks [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], participants were asked to exercise at the target heart rates of 85% of the maximal heart rate for a minimum of 40 min/session during the aerobic sessions. Participants were instructed to perform at least three sessions a week of aerobic training (combination of treadmill, cycling, and rowing machine with interval training) followed by weekly resistance training (weight training and core exercises) from weeks 1-12.…”

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

“…Overall, 30 consecutive children and adolescents with type 1 diabetes (age range [5][6][7][8][9][10][11][12][13][14][15][16][17] years, male: 53%) were recruited at our pediatric endocrinology department and enrolled in this prospective cohort. Among children with diabetes, HBA 1c ranged from 6.8% to 12.7% , 63% of the patients with diabetes patients had HBA 1C > 8 % and mean diabetes duration was 5.1 ± 3.1 years.…”

“…The relationship between type 1 diabetes and cardiac structure and function in children and adolescents was poorly documented. Most of the previous echocardiographic studies have used standard techniques relatively insensitive to the detection of early myocardial dysfunction [9,10] . Strain and strain rate, derived from tissue Doppler imaging (TDI), have been proposed as parameters for the early detection of myocardial dysfunction [11] .…”

Influence of Type 2 Diabetes and the Sex on the Occurrence of Sub-Clinic Left-Ventricular Diastolic Dysfunction of the Heart

“…Women with type 2 diabetes have a higher risk of death from cardiovascular diseases in comparison to men with type 2 diabetes. Independently from the influence of diabetes in cardiovascular morbidity and mortality, the influence of diabetes and diabetes-sex interaction, in the distribution of subclinical left ventricular diastolic dysfunction at the people sick with type 2 diabetes and in absence of coronary disease, high blood pressure disease and other well known heart diseases, they are not clearly defined and the data is controversial [2,59,[61][62][63][64][65][66][67][68].…”