Abnormal vascular thickness and stiffness in young adults with type 1 diabetes: new insights from cutting-edge ultrasound modalities

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with Type 1 Diabetes (T1D). Early markers of CVD include increased carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), but these existing ultrasound technologies show limited spatial and temporal resolution in young adults. The purpose of this study is to evaluate the utility of high-resolution ultrasound modalities, including high frequency ultrasound CIMT (hfCIMT) and ultrafast ultrasound PWV (ufPWV), in young adults with Type 1 Diabetes.

Methods: This is a prospective single-center observational cohort study including 39 participants with T1D and 25 age and sex matched controls. All participants underwent hfCIMT and ufPWV measurements. hfCIMT and ufPWV measures of T1D were compared with controls and associations with age, sex, BMI, A1c, blood pressure, and lipids were studied.

Results: Mean age was 24.1 years old in both groups. T1D had a greater body mass index (27.7 [5.7] vs 23.1 [3.2] kg/m²), LDL Cholesterol, and estimated GFR, and had a mean A1c of 7.4 [1.0] % (57 mmol/mol) and diabetes duration of 16.1 [3.7] years with 56% using insulin pumps. In T1D, hfCIMT was significantly increased as compared to controls (0.435 ± 0.06 mm vs 0.379 ± 0.06 mm respectively, p < 0.01). ufPWV measures were significantly increased in T1D (systolic foot PWV: 5.29 ± 0.23 m/s vs 5.50 ± 0.37 m/s, p < 0.01; dicrotic notch PWV = 7.54 ± 0.46 m/s vs 7.92 ± 0.41 m/s, p < 0.01). Further, there was an impact of A1c-measured glycemia on hfCIMT, but this relationship was not seen with ufPWV. No significant statistical correlations between hfCIMT and ufPWV measures in either T1D or healthy controls were observed.

Conclusion: Young adults with T1D present with differences in arterial thickness and stiffness when compared with controls. Use of novel high-resolution ultrasound measures describe important relationships between early structural and vascular pathophysiologic changes and are promising tools to evaluate pre-clinical CVD risk in youth with T1D.

Trial registration: ISRCTN91419926.

Keywords: Cardiovascular disease; Carotid intima-media thickness; High frequency ultrasound; Pulse wave velocity; Type 1 diabetes; Ultrafast ultrasound imaging.

Fig. 1

Pictorial representation of study protocol. Participants underwent recording of hfCIMT and ufPWV at the same location on the carotid artery in a supine, resting position. Inserts below in-figure text show sample raw data of hfCIMT (top) and PWN-DN (bottom). PWV is calculated from the slope of the position-time graph, as determined by radon transform, depicted by the black line at the 400s mark

Fig. 2

hfCIMT (a) and ufPWV (b) significantly greater in people with T1D versus healthy controls. Data represented as box-and-whisker plots. Control healthy controls, T1D people with type 1 diabetes, CIMT carotid intima-media thickness, PWV pulse wave velocity, PWV-SF systolic foot PWV, PWV-DN dicrotic notch PWV. * denotes p < 0.01