الفهرس 
DIIABETES MELLIITUSOnly 14 pages are availabe for public view
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Abstract
T
ype 1 diabetes mellitus (DM) leads to functional and structural arterial vessel wall alterations, resulting in stiffening of the arterial system In turn, increased arterial wall stiffness is an important predictor of cardiovascular disease in type 1 DM.
A close relationship has been established between indexes of arterial stiffening and progressive micro vascular damage in the kidneys that leads to renal failure.
The mechanism of this relationship is complex, because a decrease in aortic wall elasticity may contribute to renal dysfunction by transmission of high-pulsatile flow to the kidneys, and, conversely, renal dysfunction may also contribute to increased aortic stiffness. Most of the studies describing arterial stiffness and the kidneys have been conducted in patients with chronic kidney disease, and similar findings have been noted in patients with DM with microalbuminuria. However, whether type 1 DM is associated with increased aortic stiffness, independently of renal dysfunction, has not been studied in detail before, to our knowledge. Therefore, we selected patients with type 1 DM with normal renal function to avoid the possible confounding effect of renal dysfunction that may aggravate reduction in vascular elasticity. On the other hand, diabetic nephropathy is one of the major complications of type 1 DM, and a gradual progressive process of aortic stiffening, renal damage, and their interaction can be assumed in chronic type 1 DM disease, appearing before the onset of clinically detectable renal damage. This notion could be substantiated if an independent relationship could be established between aortic stiffness and renal function within the normal range in type 1 DM.
Velocity-encoded MRI is well suited to assess aortic stiffness independently of geometric assumptions, unlike other methods frequently used in clinical studies, such as tonometry and ultrasound Furthermore; MRI-based pulse wave velocity (PWV) measurements have been well validated in comparison with invasive pressure recordings.
This cross sectional study was carried out on 30 children and adolescents with type 1 diabetes mellitus (13 males and 17 females with a meal- to female ratio 1:1.3) attending the pediatric diabetes Clinic, pediatric Hospital, Ain Shams University and another group of 20 age- and sex -matched healthy individuals: 10 males and 10 females (ratio1:1) were enrolled as controls. The mean age of patients was (14.23±2.16) years range (12-22) years while that 0f controls was (14.7±2.27) years (rang, 12-22). All the included patients were subjected to:
(1) Detailed medical history with special emphasis on age at onset of diabetes, disease duration, and chronic diabetes complications.
(2) Thorough clinical examination laying stress on anthro-pometric measures, blood pressure, fundus examination and neurological assessment.
(3) Laboratory investigations including measurement of mean random blood glucose levels in the last 3 months prior the study.
Liver function test including ALT, AST using Synchrony CX9 Auto analyzer (Brea, California, USA) and kidney function testes, fasting lipid profile; serum total and high-density lipoprotein (HDL) cholesterol and triglycerides using Cobasintegra 800 (Roche Diagnostics, Mannheim, Germany).
Assessment of mean HbA1C % over the last three months prior to the study using D-10 (Bio Rad, France).
Urinary albumin excretion (UAE) in an early morning fasting urine sample as albumin-to-creatinine ratio by an immuno-turbidimetric method (Cobasintegra 800; Roche diagnostics, Mannheim, Germany). Patients were classified according to UAE in at least 2 out of 3 consecutive urine samples, 2 months apart into 3 groups; the normoalbuminuria group (UAE<30 mg/g creatinine), microalbuminuria group(30-299 mg/g creatinine) or the microalbuminuria group (UAE≥300 mg/g creatinine).
Radiological Investigation Aortic stiffness measured by MRI scanning on a 1.5T whole-body MRI scanner (NTGyroscan Intera, Philips Health care) using a dedicated twelve-element phased-array cardiac coil. External ultrasound measured the carotid intima media thickness.
This study revealed the following:
Highly statistical significant difference between patients & controls as regard family history of diabetes (p<0.004).
Highly statistical significant difference between patients & controls as regard height and diastolic blood pressure.
Highly statistical significant difference between patients & controls as regard height percentile and BMI percentile.
Highly statistical significant difference between patients & controls as regard random blood sugar, AST, creatinine, urea, HDL, LDL, cholesterol and Triglyceride. The comparisons between patients and control as regards radiological measurement there was highly statistical significant difference of the patients compared with controls. There was correlation between patients and controls as regard carotid intimae media thickness right & left. Also there was positive correlation between patients and controls as regard carotid intimae media thickness right and random blood sugar.
There was negative correlation between patients and controls as regard carotid intimae media thickness right and microalbuminuria.
Also there were negative correlation controls as regard carotid intimae media thickness left & microalbuminuria.
This study revealed the following:
No statistical significant difference between patients and control as regard sex and age. No statistical significant difference between patients and control as regard weight, BMI, systolic blood pressure. No statistical significant difference between patients and control as regard weight percentile systolic & diastolic percentile. No statistical significant difference between patients and control as regard ALT .the comparisons between patients and control as regards radio logical measurement there were no statistical significant difference of carotid thickness right & left.
No relation between aortic wave value and sex, family history of diabetes ,frequency of monitoring of diabetes, complication of diabetes and mean duration of hospital admission .no correlation between aortic wave value and carotid intima media thickness right &left. No correlation between aortic wave value and age, age of onset of diabetes and disease duration.
No correlation between aortic wave value and weight, height and BMI.
No correlation between aortic wave value and systolic diastolic blood pressure. There were no between aortic wave value and random blood sugar, ALT, AST, HDL, LDL, cholesterol, triglyceride, microalbminuria and HbA1C.No relation between right & left carotid intimae media thickness and sex, family history of diabetes, frequency of monitoring of blood glucose, complication of diabetes mellitus and mean duration of hospital admission.
No correlation of right & left carotid intima media thickness and aortic wave value.
Also no correlation between right & left carotid intima media thickness and age, age of onset of diabetes and disease duration. There were no correlation of right & left carotid intima media thickness and systolic and diastolic blood pressure.
There were no correlation of right & left carotid intima media thickness and systolic and There were no correlation right & left carotid intima media thickness and No correlation between right & left carotid intima media thickness and weight, height and BMI. No correlation between right & left carotid intima media thickness and systolic and diastolic blood pressure.