Peripheral artery tonometry demonstrates altered endothelial function in children with type 1 diabetes.
OBJECTIVE
To assess the ability of reactive hyperemia-peripheral artery tonometry (RH-PAT) to serve as a surrogate marker of endothelial dysfunction in children with type 1 diabetes (T1D).


METHODS
Forty-four children with T1D [age 14.6 +/- 2.7 yr; duration of diabetes 6.01 +/- 4 yr; range of diabetes duration 1-16 yr; and hemoglobin A1c (HbA1c) 8.34 +/- 1.2%] and 20 children without diabetes (age 14.1 +/- 1.5 yr) underwent RH-PAT endothelial function testing after an overnight fast. Height, weight, body mass index (BMI), blood pressure (BP), fasting lipid profile, and glucose level were determined in each child. Children with T1D underwent a second RH-PAT study 4 wk after their initial study to determine the intrapatient variability of the technique.


RESULTS
Children with T1D had endothelial dysfunction as evidenced by lower mean RH-PAT scores (1.63 +/- 0.5) when compared with children without diabetes (mean RH-PAT score 1.95 +/- 0.3) (p = 0.01). Repeat RH-PAT scores were predicted by initial RH-PAT scores (p = 0.0025). Mean intrapatient standard deviation of RH-PAT score was 0.261 and mean coefficient of variation was 14.8. Variations in RH-PAT score were not explained by differences in glucose, HbA1c, BMI, systolic BP, diastolic BP, or lipids.


CONCLUSIONS
Although larger validation studies are required, RH-PAT is a promising non-invasive technique to assess endothelial function in children with T1D. Non-invasive measures of endothelial dysfunction may provide the additional risk stratification data needed to justify more aggressive primary prevention of cardiovascular disease in children with T1D.
Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, USA. hallemj@peds.ufl.edu
Michael J
MJ
Haller
Jennifer
J
Stein
Jon
J
Shuster
Douglas
D
Theriaque
Janet
J
Silverstein
Desmond A
DA
Schatz
Michael G
MG
Earing
Amir
A
Lerman
Farid H
FH
Mahmud
D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon
D006442:Glycated Hemoglobin