title: Assessing endothelial dysfunction in adolescents and young adults with type 1 diabetes mellitus using a non-invasive heat stimulus.
abstract: BACKGROUND
  Microvascular dysfunction is a key event in the development of atherosclerosis, which predates the clinical manifestations of vascular disease including stroke and myocardial infarction. Dysfunction of the microvasculature can be measured as a decreased microperfusion in response to heat.
  
  
  OBJECTIVE
  We sought to evaluate the microvasculature using heat among adolescents and young adults with type 1 diabetes (T1D) compared to healthy non-diabetic controls. We hypothesized that youth with T1D would have impaired microvascular function measured as decreased perfusion.
  
  
  METHODS
  We studied 181 adolescents and young adults with T1D and 96 age-, race-, and sex-matched healthy controls (mean age 19 yr). Patients were seen at an in-person study visit where demographics, anthropometrics, and laboratory data was obtained. Skin microvascular perfusion was measured on the volvar surface of the right forearm using a standard laser flow Doppler. Measurements were taken at baseline and after heating to 44° C.
  
  
  RESULTS
  Youth with T1D had decreased microvascular perfusion as measured by lower percent change of perfusion units (1870 ± 945 vs. 2539 ± 1255, p < 0.01) and percent change in area under the curve (1870 ± 945 vs. 2539 ± 1255, p < 0.01) compared to controls. Glycosylated hemoglobin A1c (HbA1c) was found to be an independent determinant of microvascular function (p < 0.05).
  
  
  CONCLUSIONS
  Adolescents and young adults with T1D have evidence of microvascular dysfunction that can be detected using heat, a non-invasive physiologic stimulus. HbA1c appears to play an independent role in determining microvascular perfusion suggesting tight glycemic control is probably important for the development of vascular disease.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of Endocrinology, Cincinnati, OH, 45229, USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of Cardiology, Cincinnati, OH, 45229, USA.
authors.forename: Zhiqian
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of Endocrinology, Cincinnati, OH, 45229, USA.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Dolan
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, Aurora, CO, 80202, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.affiliation: Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC, 27103, USA.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of Cardiology, Cincinnati, OH, 45229, USA.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Urbina
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D042241:Early Diagnosis; D004730:Endothelium, Vascular / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005542:Forearm; D006442:Glycated Hemoglobin / Q000032:analysis; D006358:Hot Temperature; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D055806:Microvessels / Q000276:immunology / Q000503:physiopathology*; D009820:Ohio / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012039:Regional Blood Flow; D012307:Risk Factors; D012867:Skin / Q000098:blood supply / Q000276:immunology; D014657:Vasculitis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: endothelial function; heat; pediatrics; type 1 diabetes
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