Early increase in carotid intima-media thickness in women with childhood-onset type 1 diabetes compared with healthy peers: the Norwegian Atherosclerosis and Childhood Diabetes study

Abstract

Introduction: The risk of cardiovascular disease is increased in individuals with type 1 diabetes, despite good glycemic control. This study aims to evaluate early signs of atherosclerosis and predisposing factors in individuals with childhood-onset type 1 diabetes compared with healthy controls.

Research design and methods: The Atherosclerosis and Childhood Diabetes study is a prospective population-based cohort study with follow-up every fifth year. The cohort consists of 329 subjects with type 1 diabetes and 173 controls. Carotid intima-media thickness (cIMT) was measured at baseline and 5 and 10 years of follow-up. Data from the Norwegian Childhood Diabetes Registry were used in assessment of traditional risk factors.

Results: Mean cIMT in young women with type 1 diabetes increased significantly over a 10-year period compared with healthy controls (∆0.019 mm (0.001-0.035), p=0.035). At the 10-year follow-up the group with type 1 diabetes had a mean age of 24.2±2.9 years (13.7±2.8 years at baseline), diabetes duration of 15.6±3.4 years (5.4±3.3 years at baseline) and HbA1c of 8.2±3.6% (66±16 mmol/mol) (8.4±3.4% (68±13 mmol/mol) at baseline). Women with type 1 diabetes had significantly higher mean weight, body mass index, waist circumference, diastolic blood pressure (DBP), serum low-density lipoprotein (LDL)-cholesterol and apolipoprotein B, while men with type 1 diabetes had significantly higher mean DBP and urinary albumin-creatinine ratio compared with the control group. Mean cIMT change over time was not associated with long-term HbA1c or LDL-cholesterol burden in childhood and adolescence.

Conclusion: Young women with childhood-onset type 1 diabetes of relatively short diabetes duration had a higher mean cIMT over a 10-year period compared with their healthy female controls, with values similar to males.

Keywords: Carotid Intima-Media Thickness; Diabetes Mellitus, Type 1; Glycated Hemoglobin A; Women's Health.

Figure 1. Flow chart demonstrating when the study started, every follow-up and how many individuals were included/lost in the study at baseline and 5 and 10 years of follow-up. T1D, type 1 diabetes. Created in BioRender. Rogn, A. (2025) https://BioRender.com/f33q316

Figure 2. Unadjusted mean between-group cIMT change over time for total group (A), men (B) and women (C). Unadjusted mean between-group cIMT change over a 10-year period for total group and stratified according to sex, calculated by linear mixed model. cIMT, carotid intima-media thickness; T1D, type 1 diabetes.

Figure 3. Adjusted mean between-group cIMT change over time for total group (D), men (E) and women (F). Adjusted mean between-group cIMT change over a 10-year period for total group and stratified according to sex, calculated by linear mixed model. Adjusted for covariates by age, HbA1c, body mass index (BMI), systolic blood pressure (SBP), total cholesterol, high-density lipoprotein (HDL), urinary albumin-creatinine ratio (u-ACR), and triglycerides. cIMT, carotid intima-media thickness; T1D, type 1 diabetes.