Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.
BMJ Open Diabetes Res Care. 2020 Jul;8(1). doi: 10.1136/bmjdrc-2020-001216.
We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes.
47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size.
39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found.
There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk.
NCT02637154.
我们研究了在接受标准教育护理（SEC）的基础上增加动机性访谈（MI）是否能改善控制不佳的 1 型糖尿病青少年的血管健康。
47 名病程至少 2 年且两次就诊时糖化血红蛋白 A1c>75mmol/mol（>9.0%）的 1 型糖尿病青少年随机分为 MI+SEC 或 SEC 组。我们还比较了试验基线时 1 型糖尿病患者的血管健康参数与年龄和体型匹配的健康历史对照组。
39 名青少年（20 名 MI+SEC）完成了血管健康研究。12 个月时，MI+SEC 和 SEC 之间的参数变化无统计学意义差异（颈动脉-股动脉脉搏波速度（cfPWV）：平均差异 0.052m/s（95%CI-0.395 至 0.500，p=0.81）；颈动脉-桡动脉脉搏波速度（crPWV）：0.118m/s（95%CI0.478 至 0.713，p=0.69），颈动脉内中膜厚度（IMT）：0.002mm（95%CI-0.37 至 0.40，p=0.93），收缩压（BP）z 评分：0.495（95%CI-0.099 至 1.09，p=0.10）。基线时，1 型糖尿病病程与桡动脉 IMT（r=0.430，p=0.007）和 cfPWV（r=0.373，p=0.018）相关，颈动脉、股动脉和肱动脉 IMT 与连续血糖监测（CGM）SD 相关（r=0.440，p=0.017；r=0.377，p=0.048；r=0.387，p=0.038）。CGM 时间范围内（3.9-10.0mmol/L）与 crPWV 变化呈负相关（r=-0.476，p=0.022）。收缩压变化与体重指数变化相关（r=0.374，p=0.019）和 IMT 变化相关（r=0.461，p=0.016 为颈动脉 IMT；r=0.498，p=0.010 为股动脉 IMT）。与健康对照组相比，基线时 1 型糖尿病患者的 PWV 较高，颈总动脉顺应性较低，但未发现其他差异。
在 SEC 的基础上增加 MI 对血管健康参数没有影响。尽管疾病持续时间和血糖控制与基线时的血管健康相关，但血糖控制与血管健康参数变化之间只有有限的关联。血管健康参数变化相互关联，提示心血管风险的聚集。
NCT02637154。
