Risk Factors for Subclinical Atherosclerosis in Diabetic and Obese Children

Abstract

Background. Increased carotid intima-media thickness (cIMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events both in obese and diabetic subjects. We aimed to evaluate early signs of atherosclerosis and investigate for predisposing factors in children and adolescents affected by type 1 diabetes (T1DM) or obesity, comparing them with healthy controls.Methods. Out of 71 enrolled subjects (mean age 12.8 ± 2.3 years), 26 had T1DM and 24 were obese, while 21 age- and sex-matched subjects acted as controls. cIMT was measured using standardized methods. Serum glucose, insulin, cholesterol, triglycerides and C-reactive protein levels were evaluated. An oral glucose tolerance test (OGTT) was performed in obese subjects.Results. Diabetic and obese individuals showed higher cIMT mean values than healthy controls (p<0.005). cIMT of the three examined segments correlated positively with fasting glucose levels and negatively with units of insulin/kg/day administered in T1DM individuals. A positive correlation between insulin levels (basal and after oral glucose load) and cIMT of common, internal and external carotid artery was found in obese subjects (p<0.03). High density cholesterol levels represented a protective factor for cIMT in this latter group of the study population.Conclusions. Our findings show that cIMT correlates with high insulin levels (a sign of insulin resistance) in obese patients and with high fasting glucose levels (a sign of relative insulin deficiency) in T1DM subjects, confirming the need of reducing hyperinsulinism and monitoring blood glucose levels in these subjects to prevent atherosclerosis.

Insulin resistance and endothelial function in children and adolescents

“…It is also recommended by the American Heart Association as a noninvasive imaging parameter for detecting atherosclerosis [9,10]. Previous studies reported that cIMT correlates with high insulin levels (a sign of IR) in obese patients and with high fasting glucose levels (a sign of relative insulin deficiency) in subjects with type 1 diabetes [11]. Moreover, other ultrasound parameters have been associated with cardiovascular risk in obese subject [12].…”

Glycemic variability predicts inflammation in adolescents with type 1 diabetes

“…High sensitivity C-reactive protein (CRP) is the most studied inflammatory marker in pediatric type 1 diabetes. In healthy adults, CRP levels predict future cardiovascular disease and are linked to endothelial dysfunction [13–15], Most [6, 7, 16–22], but not all studies [23, 24], have demonstrated significant increases in CRP levels in pediatric T1D patients. Soluble intracellular adhesion molecule 1 (sICAM 1) is biochemical marker of endothelial damage and inflammation and is again elevated in pediatric T1D [7, 20, 25–27].…”

Endothelial and Metabolic Function Interactions in Overweight/Obese Children:

“…The consequences of childhood obesity are because of the increase in meta-children, thus becoming more susceptible to cardiovascular events in adult life 16) . Furthermore, other studies have demonstrated that cIMT correlates with high insulin levels in obese patients 17,18) .…”