title: Longitudinal evaluation of endothelial function in children and adolescents with type 1 diabetes mellitus: a long-term follow-up study.
abstract: BACKGROUND
  Type 1 diabetes (T1DM) predisposes to cardiovascular disease, increasing the risk to develop atherosclerosis. In the pediatric population, the cardiovascular risk may be evaluated examining endothelial function by a non-invasive ultrasound technique, namely flow-mediated dilation (FMD) of the brachial artery. The aims of this study were the longitudinal evaluation of the potential change in the endothelium-dependent vasomotor function in children and adolescents with T1DM and the identification of clinical and laboratory data correlated to modifications.
  
  
  METHODS
  We studied 39 T1DM patients (20 girls and 19 boys; aged 11.2 ± 3.72 years). FMD and blood samples were obtained from all patients at baseline (time 0) and after a follow up of at least 1 year (time 1). FMD was also evaluated in 45 healthy controls (22 boys, 23 girls) aged 10.2 ± 3.05 years.
  
  
  RESULTS
  At time 0, 43.6% of T1DM patients presented an impaired FMD. FMD at time 1 revealed a dramatic impairment of endothelial function: altered FMD values were shown in 61.5% of patients and it got worse in 74.3% of them. Longitudinally, boys had a greater impairment of FMD than girls. At baseline, multivariate analysis identified only sex as significant predictor of FMD (β = 0.470, P = 0.029).
  
  
  CONCLUSIONS
  Because endothelial dysfunction appears earlier in diabetic children, they are at higher risk to develop atherosclerosis. Our results suggest the usefulness of FMD as a tool to stratify pediatric T1DM patients according to their cardiovascular risk and to follow them up longitudinally.
authors.affiliation: Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Bruzzi
authors.forename: Barbara
authors.initials: B
authors.lastname: Predieri
authors.forename: Viviana Dora
authors.initials: VD
authors.lastname: Patianna
authors.forename: Annamaria
authors.initials: A
authors.lastname: Salvini
authors.forename: Rosario
authors.initials: R
authors.lastname: Rossi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Iughetti
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D013997:Time Factors
keywords: atherosclerosis; endothelial function; flow-mediated dilation; glycosylated hemoglobin; type 1 diabetes mellitus