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Open Access Highly Accessed Research article

Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes: a pilot cross-sectional study

Sarah P M Hosking12*, Rani Bhatia13, Patricia A Crock134, Ian Wright1359, Marline L Squance568 and Glenn Reeves5678

Author Affiliations

1 John Hunter Children’s Hospital, New Lambton, NSW 2305, Australia

2 Monash University, Melbourne, VIC 3168, Australia

3 Discipline of Paediatrics and Child Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia

4 Department Paediatric Endocrinology and Diabetes, John Hunter Children’s Hospital, New Lambton, NSW 2305, Australia

5 Hunter Medical Research Institute, New Lambton, NSW 2305, Australia

6 Autoimmune Resource and Research Centre, New Lambton, NSW 2305, Australia

7 John Hunter Hospital, New Lambton, NSW 2305, Australia

8 School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia

9 Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia

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BMC Endocrine Disorders 2013, 13:41  doi:10.1186/1472-6823-13-41

Published: 5 October 2013

Abstract

Background

The detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes.

Methods

Patients aged between 8 – 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher’s exact and t-tests determined the association with clinical findings.

Results

26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy.

Conclusions

This pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes.

Trial registration

Clinical Trial number NCT01279928, ClinicalTrials.gov

Keywords:
Type 1 diabetes; Nailfold capillaroscopy; Laser Doppler flowmetry; Retinal vessel analysis; 24-hr ambulatory blood pressure monitoring; Microvascular disease