[Carotid artery intima-media thickness (cIMT) in young type 1 diabetic patients in relation to comorbid additional autoimmune diseases and microvascular complications]

Bożenna Klonowska, Dorota Charemska, Jolanta Jabłońska, Agnieszka Banach, Anna Kącka, Edyta Szynkarczuk, Malwina Konopka, Elżbieta Jarocka-Cyrta, Dariusz Załuski, Barbara Głowińska-Olszewska
Pediatric Endocrinology, Diabetes, and Metabolism 2016, 22 (3)

INTRODUCTION: Atherosclerosis, which is the cause of diseases of the cardiovascular system, and frequent and serious complications of type 1 diabetes (T1DM), has an autoimmune origin. Some diseases of this type, as rheumatoid arthritis, but also Hashimoto thyroiditis or celiac disease are associated with a higher incidence of heart disease. So far no studies evaluated the preclinical phase of development of atherosclerosis (cIMT) in young patients with T1DM and the comorbid additional autoimmune diseases.

AIM OF THE STUDY: was evaluation of cIMT (carotid intima media thickness) carotid arteries and the risk factors of atherosclerosis in young patients with type 1 diabetes according to the comorbid autoimmune diseases and a comparison group of patients with known vascular complications and a group of healthy people.

PATIENTS AND METHODS: The study involved a group of 90 adolescents and young adults with T1DM in middle age 17,1±3years, with an average disease duration of 10,5±3,3 years. Diabetes patients were divided into 4 groups - diabetes without complications - C, diabetes with celiac disease - CC, diabetes with Hashimoto's thyroiditis - CH, diabetes with vascular complications - CN. The control group (K) consisted of 22 healthy age-matched volunteers. In statistical analysis rated: average A1C of all the years of illness, BMI, blood pressure, lipid values, duration of illness, presence of diabetes complications, daily insulin dose and cIMT thickness of the common carotid artery.

RESULTS: cIMT of T1DM patients was significantly higher: 0,470 mm than in healthy: 0,409 mm. In the group with vascular complications of diabetes was found the highest rate of cIMT: 0,501 mm in comparison to the group of diabetes without complications: 0,462 mm, diabetes with celiac disease: 0,462 mm, and diabetes with Hashimoto's thyroiditis: 0,453 mm. HbA1c was highest in the group CN: 9,84±1,5%, compared to CH: 9,04± 1,2%, CC: 8,84±1,8% and C without complications: 8,55±1,2%. BMI was highest in the group CN: 23,3± 4,4kg/m2and CH: 22,6 ± 2,4 kg/m2. It was the same with waist circumference: CN: 79,33± 9,39and CH: 79,2 ± 9,56 cm. Patients with vascular complications were characterized by the higher value of blood pressure and lipids compared to patients with additional autoimmune disease. Coexistence of celiac disease was not associated with a greater value of cIMT and cardiovascular risk factors in young patients with type 1 diabetes.

CONCLUSIONS: 1. Increased value of cIMT, and thus increased risk of early disease of the cardiovascular system depends primarily on metabolic compensation and classic risk factors for atherosclerosis. 2. The coexistence of additional autoimmune disease does not significantly affect the value of cIMT in the study population. 3. Young patients with diabetes type 1 and coexisting Hashimoto disease have greater BMI and waist circumference, what can lead to earlier macroangiopathy in the future.

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