The effect of cardiovascular risk factors on the longitudinal evolution of the carotid intima medial thickness in children with type 1 diabetes mellitus

Background: Type 1 diabetes mellitus is a generally accepted atherogenic risk factor. The aim of this prospective longitudinal study was to evaluate changes in carotid intima media thickness (cIMT) in children and adolescents with type 1 diabetes mellitus (T1DM) using standardized methods. Methods: We re-evaluated cIMT in 70 (38 f) of initial 150 (80 f) patients with T1DM after 4 years. At re-evaluation, mean (+/- SD) age was 16.45 +/- 2.59 y, mean diabetes duration was 9.2 +/- 3.24 y and patients had a mean HbA1c of 8.14 +/- 1.06%. Results: Mean cIMT z-scores increased significantly during 4 years (0.58 +/- 0.75, p < 0.001) as well as BMI-z-score (0.41 +/- 0.81, p < 0.01), systolic blood pressure (0.77 +/- 1.15, p < 0.01) and HbA1c (0.90 +/- 1.07, < 0.001). In a linear regression model systolic blood pressure z-score at first measurement (0.02, CI: 0.01, 0.04) was a significant predictor for the mean effect on cIMT z-score. In a logistic regression model significant risk factors for an increase in IMT of >= 1.5 z-scores were BMI z-scores (OR: 3.02, CI: 1.11, 10.14), diabetes duration (OR: 1.32, CI: 1.04, 1.77) and systolic blood pressure (OR: 1.14, CI: 1.04, 1.27) at first measurement each. Conclusions: Longitudinal cIMT measurements revealed progression in subclinical atherosclerosis during a four year period in diabetic children and adolescents. Systolic blood pressure and BMI were related to cIMT increment. Control of these risk factors by lifestyle and medical intervention may prevent progression of cIMT in diabetic children.