The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it

Abstract

The major cause of morbidity and often premature mortality in people with type I diabetes (T1D) is cardiovascular disease owing to accelerated atherosclerosis. We review publications relating to the rationale behind, and clinical tests for, detecting and treating early atherosclerosis in people with T1D. Currently available tools for atherosclerosis assessment include risk equations using vascular risk factors, arterial intima–media thickness, the ankle–brachial index, coronary artery calcification and angiography, and for more advanced lesions, intravascular ultrasound and optical coherence tomography. Evolving research tools include risk equations incorporating novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging. As yet there is little information available to quantify early atherosclerosis. With better means to control the vascular risk factors, such as hypertension, dyslipidaemia and glycaemic control, and emerging therapies to control novel risk factors, further epidemiologic and clinical trials are merited to facilitate the translation into clinical practice of robust means to detect, monitor and treat early atherosclerosis in those with T1D.

The Relationship between Selected Inflammation and Oxidative Stress Biomarkers and Carotid Intima-Media Thickness (IMT) Value in Youth with Type 1 Diabetes Co-Existing with Early Microvascular Complications

“…The risk of vascular complications development in type 1 diabetes in children, greater with worse metabolic control, is also exacerbated by lipid disorders [ 58 ]. The described results are in line with many formerly published research works considering youth diabetic cases [ 33 , 59 ].…”

From Diabetes to Atherosclerosis: Potential of Metformin for Management of Cardiovascular Disease

“…To avoid the development of cardiovascular disease, early intervention is necessary. A randomized, controlled, double-blind, 1-year study that involved 90 people demonstrated that metformin at a dosage of 1 g twice a day is capable of improving SMCs and HbA1c function in children with T1DM and reducing insulin doses [ 69 ].…”

Cardiovascular diseases in youth patients with glucose metabolism impairment

“…Endothelial dysfunction defined as an abnormal vascular response to endothelium-dependent vasodilators can be assessed by non-invasive ultrasound methods, while endothelial activation is detected by testing the concentration of substances produced by the endothelium in the blood serum. Jenkins et al draws attention to the need to improve diagnostic methods for measuring arterial intima-media thickness, coronary artery calcification and angiography, and other methods like intravascular ultrasound and optical coherence tomography [34]. The same authors also emphasize the need to improve novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging.…”