title: Endothelial progenitor cells are related to glycemic control in children with type 1 diabetes over time.
abstract: OBJECTIVE
  The risk of cardiovascular death before the age of 40 is 20-fold higher in patients with type 1 diabetes mellitus (T1DM). Endothelial progenitor cells (EPCs) predict cardiovascular morbidity and mortality in patients without diabetes. We hypothesized that EPCs are modified in children with T1DM and are related to characteristics of T1DM such as glycemic control.
  
  
  METHODS
  Children (n = 190; 156 T1DM subjects and 34 control subjects) were included in an observational cohort study and matched for age and sex. EPCs were enumerated by flow cytometry at the beginning (cross-sectional) and 1 year later (longitudinal). To analyze changes of variables during the observation, Δ values were calculated.
  
  
  RESULTS
  EPCs were significantly reduced in T1DM children versus control subjects (609 ± 359 vs. 1,165 ± 484, P < 0.001). Multivariate regression modeling revealed that glycated hemoglobin A1c (HbA1c) was the strongest independent predictor of EPCs (β = -0.355, P < 0.001). Overall glycemic control at the beginning and end of study did not differ (7.8 ± 1.2 vs. 7.8 ± 1.2 relative %, P = NS), but we observed individual HbA1c changes of -4.30/+3.10 relative %. The strongest EPC increase was observed in the patients with the most favorable HbA1c lowering during the 1-year follow-up. Accordingly, the strongest EPC decrease was demonstrated in the patients with the strongest HbA1c worsening during the time period.
  
  
  CONCLUSIONS
  This is the first prospective study demonstrating diminished EPCs in children with T1DM. The association of better glycemic control with an increase in EPC numbers within 1 year suggests that a reduction of the high cardiovascular disease burden might be mediated likewise.
authors: Department of Pediatric and Adolescent Medicine, Medical University of Vienna and Vienna General Hospital, Vienna, Austria.
authors: Thomas
authors: T
authors: Hörtenhuber
authors: Birgit
authors: B
authors: Rami-Mehar
authors: Miriam
authors: M
authors: Satler
authors: Katrin
authors: K
authors: Nagl
authors: Clemens
authors: C
authors: Höbaus
authors: Florian
authors: F
authors: Höllerl
authors: Renate
authors: R
authors: Koppensteiner
authors: Guntram
authors: G
authors: Schernthaner
authors: Edith
authors: E
authors: Schober
authors: Gerit-Holger
authors: GH
authors: Schernthaner
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000378:metabolism* / Q000503:physiopathology; D042783:Endothelial Cells / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D013234:Stem Cells / Q000378:metabolism*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin