Hemoglobin A1c and retinal arteriolar narrowing in children with type 1 diabetes: the diagnostics of early atherosclerosis risk in kids study

Abstract

Background/Objective Microvascular alterations play a key role in the development of diabetes complications. Retinal vessel analysis is a unique method to examine microvascular changes in brain‐derived vessels. Methods Sixty‐seven pediatric and adolescent type 1 diabetes patients and 58 healthy control persons (mean age 12.4 ± 2.9 years) underwent non‐mydriatic retinal photography of both eyes. Central retinal arteriolar and central retinal venular (CRVE) diameter equivalents as well as the arteriolar‐to‐venular ratio were calculated using a semiautomated software. All anthropometric and laboratory parameters were measured according to standardized procedures for children. Results Retinal vessel diameter did not differ between type 1 diabetic children and healthy controls. However, there was an independent association of higher hemoglobin A1c (HbA1c) levels with arteriolar narrowing. Arteriolar narrowing of 5.4 μm was observed with each percent increase in HbA1c. Longer duration of diabetes was associated with wider retinal arterioles. CRVE was not associated with diabetes duration or HbA1c. Conclusions Microvascular arteriolar alterations are already present in childhood and may indicate subclinical atherosclerosis and increased risk of diabetes complications later in life. Future research will have to investigate the potential use of retinal vessel diameters for treatment monitoring and guidance of therapy in children.

A two-year longitudinal observational study of the peripapillary microvasculature in pediatric type 1 diabetes mellitus patients without visual impairment or diabetic retinopathy

“…Blood glucose levels are highly relevant to microvasculature damage. 17 , 33 Although the difference in HbA1c% levels between the two timepoints is only a crude reflection of average blood glucose during the follow-up period, it could provide information on the effects of behavioral change and externally imposed interventions on children's blood glucose control.…”

The anti‐angiogenesis role of FBXW7 in diabetic retinopathy by facilitating the ubiquitination degradation of c‐Myc to orchestrate the HDAC2

“…5 The change of retinal microcirculation is the precursor of DR. 6 This is due to retinal vascular damage and retinal blood barrier caused by diabetes. 7,8 Therefore, it is necessary to strengthen the research on the molecular mechanism of inhibiting angiogenesis DR so as to develop new therapeutic methods for DR.…”