title: Endothelial dysfunction is related to poor glycemic control in adolescents with type 1 diabetes under 5 years of disease: evidence of metabolic memory.
abstract: BACKGROUND
  The relation between endothelial dysfunction (ED), glycemic control, and early type I diabetes mellitus (T1DM) is unclear.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the association of ED, glycemic control, and the duration of diabetes in T1DM.
  
  
  METHODS
  This was a cross-sectional study.
  
  
  METHODS
  The study was conducted at a public outpatient clinic.
  
  
  METHODS
  Fifty-seven T1DM adolescents and 10 healthy age-matched controls participated in the study.
  
  
  METHODS
  There were no interventions.
  
  
  METHODS
  Endothelial function (ED) was evaluated by flow-mediated dilation (FMD) in the brachial artery after reactive hyperemia. Biochemical data, including HbA1c (glycohemoglobin), high-sensitivity C-reactive protein, lipids, and urinary albumin excretion were collected. Means of four HbA1c values collected at 3-month intervals in the first and second year before FMD analyses were obtained.
  
  
  RESULTS
  Mean FMD was decreased in T1DM compared with controls (P = 0.023), independent of age, smoking, hypertension, or dyslipidemia. Twenty-eight of 57 T1DM patients enrolled (49%) had ED. FMD was decreased in microalbuminuric (4.1%) compared with normoalbuminuric patients (10.1%, P = 0.01) and controls (14.6%, P < 0.001). FMD correlated inversely with mean second-year HbA1c (r = -0.426, P = 0.02), particularly in patients with less than 5 yr of T1DM (r = -0.61, P = 0.004). In these patients, high-sensitivity C-reactive protein was strongly correlated with mean first-year HbA1c (r = -0.66, P = 0.0003). In patients with more than 5 yr of T1DM, we found no significant correlations between ED and glycemic control.
  
  
  CONCLUSIONS
  Endothelial dysfunction is common in T1DM adolescents with less than 5 yr of disease. It is associated with duration of disease, microalbuminuria, and mean second-year HbA1c but not with mean first-year HbA1c. These data support the metabolic memory hypothesis.
authors.affiliation: Programa de Pós-Graduação em Medicina: Ciências Médicas/Universidade Federal do Rio Grande do Sul, CEP 90035-003, Porto Alegre, Brazil.
authors.forename: Gislaine Vissoky
authors.initials: GV
authors.lastname: Cé
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Rohde
authors.forename: Antônio Marcos Vargas
authors.initials: AM
authors.lastname: da Silva
authors.forename: Márcia Khaled
authors.initials: MK
authors.lastname: Puñales
authors.forename: Márcia Khaled Puñales
authors.initials: MK
authors.lastname: Coutinho
authors.forename: Andrea Cauduro
authors.initials: AC
authors.lastname: de Castro
authors.forename: Marcello Casaccia
authors.initials: MC
authors.lastname: Bertoluci
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000150:complications; D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism*; D001916:Brachial Artery / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000378:metabolism / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008055:Lipids / Q000097:blood; D008297:Male; D012907:Smoking / Q000009:adverse effects; D014664:Vasodilation / Q000502:physiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D008055:Lipids