Reduced Forearm Blood Flow in Children and Adolescents With Type 1 Diabetes (Measured by Near-Infrared Spectroscopy)

Abstract

OBJECTIVE -The aim of this study was to measure forearm blood flow (FBF) to detect any possible changes that might indicate vascular disorders in children and adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -FBF was measured by near-infrared spectroscopy (NIRS), venous occlusion at rest, and after handgrip exercise. A total of 40 children and adolescents with type 1 diabetes and 40 healthy children and adolescents (6 -18 years) were matched for age and sex for comparison.RESULTS -In the diabetic group (age 12.79 Ϯ 2.9 years, duration of diabetes 51.5 Ϯ 36 months), FBF at rest was significantly lower (1.39 Ϯ 0.76 ml ⅐ 100 g muscle -1 ⅐ min -1 ) than in control subjects (age 12.66 Ϯ 2.9 years, FBF at rest 1.90 Ϯ 1.19 ml ⅐ 100 g muscle -1 ⅐ min -1 ). After exercise, FBF increased significantly less in the diabetic group (0.70 Ϯ 0.82 ml ⅐ 100 g muscle -1 ⅐ min -1 ) compared with the control subjects (1.15 Ϯ 1.05 ml ⅐ 100 g muscle -1 ⅐ min -1 ). FBF at rest decreased with increasing age in both groups. The change in FBF after exercise was independent of age in the diabetic group and increased with increasing age in control subjects. FBF is reduced with impaired hyperemic response after exercise in children and adolescents with type 1 diabetes.CONCLUSIONS -These data suggest that vascular disorders in childhood are detectable noninvasively by NIRS. Diabetes Care 27:1942-1946, 2004D iabetes is one major risk factor for development of vascular disorders. Vascular disorders described in childhood are microvascular complications of the eye, kidney disorders (low creatinine clearance, fluctuating microproteinuria), or echocardiographic changes (1-4).With near-infrared spectroscopy (NIRS), a relatively new technique, an assessment of skeletal muscle blood flow, especially of the small vessels, is possible and has been validated in several studies (5-9). By means of NIRS, impaired peripheral muscle blood flow and oxygenation has been detected in adult patients with diabetes, peripheral vascular disease, and heart failure (10 -12).No data on muscle blood flow in children and adolescents with type 1 diabetes have been published until now. In the present study, skeletal muscle forearm blood flow (FBF) was measured by means of NIRS in children and adolescents with type 1 diabetes without otherwise clinically detectable microangiopathy and in healthy control subjects. The aim of the present study was to investigate whether muscle blood flow measured by NIRS is already impaired in children and adolescents with type 1 diabetes in the absence of any other clinical signs of vasculopathy. RESEARCH DESIGN ANDMETHODS -Children and adolescents with type 1 diabetes aged 6 -18 years were studied. Patients with microalbuminuria and eye diseases were excluded from the study. Furthermore, patients had to have no evidence of neuropathy, cardiac failure, or intermittent claudication. Both patients with type 1 diabetes and control subjects who were obese or had taken any medication (except insulin) within the last 7 days were exclud...

Forearm Oxygen Consumption and Forearm Blood Flow in Healthy Children and Adolescents Measured by Near Infrared Spectroscopy

“…VO 2 decreased with increasing age. FBF decreased with increasing age, too, as we have recently reported [6].…”

“…Nevertheless, most studies on muscle oxygenation and hemodynamics were performed on healthy adults and adult patients [1,4,7] and on term and preterm neonates [8,9]. In a recent study we analyzed FBF in children and adolescents with type I diabetes and healthy children and adolescents [6].…”

“…The NIRS signal therefore predominately reflects the microcirculation and O 2 availability of tissue, which is dependent on interoptode distance, 2-6 cm deep [1]. Thus by positioning the optodes on the forearm, NIRS enables the measurement of the oxygenation and hemodynamics of forearm muscle.The venous occlusion, another noninvasive method, in combination with NIRS has been validated and has become an accepted method for the assessment of forearm muscular oxygen consumption (VO 2 ) [3][4][5] and forearm blood flow (FBF) [6]. Nevertheless, most studies on muscle oxygenation and hemodynamics were performed on healthy adults and adult patients [1,4,7] and on term and preterm neonates [8,9].…”

Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus

“…In contrast, we found that a−vO 2 was the same in diabetic as in non-diabetic adolescents. Further investigations are needed to clarify the contribution of peripheral function to the decreased aerobic capacity of diabetic adolescents, since impaired endothelial function has already been observed in this population [10]. This is a relatively small study and the results should be viewed as preliminary data.…”

Impairment of Skin Capillary Recruitment Precedes Chronic Complications in Patients with Type 1 Diabetes

“…Functional microvascular disturbances in the nail fold of the great toe in type 1 diabetic patients, evaluated by capillary blood flow velocity, have been shown to precede late diabetic complications [3,4] and to be related to poor metabolic control [5]. Nevertheless, the presence of microvascular alterations in uncomplicated type 1 diabetes is still a controversial matter [1,[6][7][8]. The present study assessed microvascular function using skin capillary recruitment during post-occlusive reactive hyperemia, which is related to endothelium-dependent vasodilatation at the precapillary level [9,10], in the upper and lower extremities of patients with type 1 diabetes without chronic complications under routine clinical care.…”