Damm Julie A, Dalgas-Madsen Amalie, Bech Agnes M K, Pilgaard Kasper A, Pociot Flemming, Hansen Tine W, Johannesen Jesper
Steno Diabetes Center Copenhagen, Herlev, Denmark.
Department of Pediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
Pediatr Diabetes. 2024 Oct 26;2024:5528717. doi: 10.1155/2024/5528717. eCollection 2024.
To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology-based cohort of children and adolescents with type 1 diabetes. Cross-sectional study, including 127 children recruited from Pediatric Diabetes Departments across Eastern Denmark between May 2022 and January 2024. Arterial stiffness was assessed as carotid-femoral pulse-wave-velocity (cfPWV) using the Sphygmocor XCEL system. Unadjusted and adjusted linear regression models explored associations between cfPWV and other risk factors. Adjustments included age, sex, diabetes duration, time-in-range, hemoglobin A1c (HbA1c), body mass index (BMI) -score, low-density lipoprotein (LDL)-cholesterol, and mean arterial pressure (MAP). Median (interquartile range [IQR]) age was 14.2 years (12.0, 16.4), diabetes duration was 4.7 years (2.7, 8.4), HbA1c level was 7.0% (6.5, 7.9), (53 mmol/l: 48-63), time-in-range was 63% (53-75), and 52% were male. The majority were treated with continuous-subcutaneous-insulin-infusion (82%), and all (except two) used continuous-glucose-monitors. The prevalence of elevated arterial stiffness (cfPWV -score over the 90th percentile) was 16%. Unadjusted analyses demonstrated higher cfPWV was associated with longer diabetes duration, higher age, HbA1c, MAP, and liver stiffness, and lower time-in-range and insulin sensitivity. Higher cfPWV remained associated with higher age (standardized (confidence interval (CI) 95%): 0.38 (0.27, 0.48); < 0.001) and lower time-in-range (-0.15 ((-0.26), (-0.03)); < 0.011) after adjustment. Despite modern treatment technology and better overall metabolic control, children and adolescents with type 1 diabetes present with a high prevalence of elevated arterial stiffness. Higher arterial stiffness was associated with higher age and lower time-in-range, independent of other risk factors, including HbA1c.
为了调查在一个基于现代欧洲技术的1型糖尿病儿童和青少年队列中，动脉僵硬度升高的患病率及其与已知和潜在新风险因素的关联。横断面研究，纳入了2022年5月至2024年1月期间从丹麦东部各儿科糖尿病科招募的127名儿童。使用Sphygmocor XCEL系统将动脉僵硬度评估为颈股脉搏波速度（cfPWV）。未调整和调整后的线性回归模型探讨了cfPWV与其他风险因素之间的关联。调整因素包括年龄、性别、糖尿病病程、血糖达标时间、糖化血红蛋白（HbA1c）、体重指数（BMI）评分、低密度脂蛋白（LDL）胆固醇和平均动脉压（MAP）。中位（四分位间距[IQR]）年龄为14.2岁（12.0，16.4），糖尿病病程为4.7年（2.7，8.4），HbA1c水平为7.0%（6.5，7.9），（53 mmol/l：48 - 63），血糖达标时间为63%（53 - 75），52%为男性。大多数患者接受持续皮下胰岛素输注治疗（82%），且所有人（除两人外）均使用持续葡萄糖监测仪。动脉僵硬度升高（cfPWV评分超过第90百分位数）的患病率为16%。未调整分析显示，较高的cfPWV与较长的糖尿病病程、较高的年龄、HbA1c、MAP和肝脏硬度相关，与较低的血糖达标时间和胰岛素敏感性相关。调整后，较高的cfPWV仍与较高的年龄（标准化（95%置信区间[CI]）：0.38（0.27，0.48）；P < 0.001）和较低的血糖达标时间（-0.15（（-0.26），（-0.03））；P < 0.011）相关。尽管有现代治疗技术和更好的总体代谢控制，但1型糖尿病儿童和青少年的动脉僵硬度升高患病率仍很高。较高的动脉僵硬度与较高的年龄和较低的血糖达标时间相关，独立于其他风险因素，包括HbA1c。
