Uncovering Cardiac Involvement in Childhood Diabetes: Is it Time to Move Toward Speckle Tracking Echocardiography in Childhood Diabetes Management?

CONTEXT

One of the most common endocrine disorders in children is diabetes which is the leading cause of premature cardiovascular disease in adulthood.

AIMS

This study is aimed to investigate the extend of cardiac involvement in diabetic children by speckle tracking echocardiography (STE) in comparison to two-dimensional (2D) echocardiography and routine laboratory data.

SETTINGS AND DESIGN

A cross-sectional study conducted on patients under 18 years of age who deal with type one diabetes mellitus for more than 5 years.

SUBJECTS AND METHODS

To compare the STE results, we included the STE data of 25 normal age-matched children. All patients underwent laboratory analysis for lipid profile, blood sugar, and 2D echocardiography plus STE.

STATISTICAL ANALYSIS USED

Two-sample independent -test, Chi-square test, logistic regression test, Spearman's rank correlation coefficient, and the Pearson correlation coefficient.

RESULTS

From March 2018 to 2019, we included 53 patients, mean age 15.8 ± 0.39 years and 52.8% female, and 25 nondiabetic control in this study. STE revealed global longitudinal strain (LS) -18.4 versus - 24.2 for patient (44 valid cases) versus control group, respectively, with significant statistical difference. Diabetic patients had lower LS in all segments compared to the control group.

CONCLUSIONS

STE has very high sensitivity to detect cardiac involvement far earlier than 2D echocardiography. None of the routine biomarkers or demographic features can predict cardiac involvement based on segmental abnormalities of STE. Active investigation to clear the remote impact of STE abnormalities and its practical role in childhood diabetes management is highly recommended.