Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes: a pilot cross-sectional study

Abstract

BackgroundThe detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes.MethodsPatients aged between 8 – 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher’s exact and t-tests determined the association with clinical findings.Results26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy.ConclusionsThis pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes.Trial registrationClinical Trial number NCT01279928, ClinicalTrials.gov

Nailfold Capillaroscopy Findings in Diabetic Patients (A Pilot Cross-Sectional Study)

“…This vascular heterogeneity may be related to significant autonomic neuropathy disturbances among population with this disease. Some other reports confirmed our results [2] [16].…”

“…microhaemorrhages in participants with diabetes (t = −2.33, P = 0.03). They demonstrated a positive association between recent HbA1c and the number of microhaemorrhages (r = 0.44, P = 0.03) [2]. We also found that isolated and irregular enlarged loops were seen more frequently in cases with scleroderma pattern.…”

“…In previous studies correlation between the severities of microvasculature changes and metabolic control of diabetes has also been reported [2]- [4]. Despite all these findings, little data exist on the relationship between microvascular changes in capillaroscopy and type 1, 2 diabetes features.…”

“…The evaluation of the capillaroscopic pattern is not based on a single parameter, but on the judgment of an overall pattern resulting from the combination of numerical and morphologic characteristics such as capillary diameter (width), capillary length, shape, distribution, mean capillary density, presence of avascular areas, haemorrhages, neoangiogenic capillaries [5] [7]. The nailfold capillary bed is accessible and revealing capillaries lie parallel to skin allowing the whole capillary loops to be visualized [2].…”

“…Some techniques like nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hour ambulatory blood pressure monitoring (24-hr ABPM) detect cardiovascular system damage once Type 1 or 2 diabetes is well established [2].…”