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New Non-invasive Methods Detect Microvascular Changes in Type 1’s

Noninvasive capilaroscopy, laser Doppler flowmetry, and retinal imaging among techniques used….

 

Type 1 diabetes usually presents in younger, thinner patients with absolute insulin deficiency. Type 1 diabetes can cause microvascular damage leading to capillary damage. Microvascular damage in type 1 diabetes is difficult to detect at earlier stages. Current techniques to detect microvascular damage are done once the disease is well established. Previous studies examining pediatric vascular changes were not well-defined: vascular changes were not identified until later in the disease state. Other studies have failed to define the specific morphological abnormalities in diabetic children. Patients with poor metabolic control have demonstrated several capillary changes.
 
This study used techniques in a pilot study to characterize microvascular changes in a pediatric cohort with type 1 diabetes of moderate duration. The cross-sectional study included 26 children and adolescents with type 1 diabetes, ages 8-18 years old and was conducted between February and October 2010. Subjects were approached at their regular endocrinologist appointment at the John Hunter Children’s Hospital, NSW, Australia. Only children with type 1 diabetes were included in this study; subjects with other autoimmune diseases were not included. Participants attended a 3 hour morning session in which the noninvasive capilaroscopy and laser Doppler flowmetry were performed; 24 hour ambulatory blood pressure monitoring (ABPM) was also conducted in session one. In the second session, the 24 hour ABPM was removed and retinal images were taken. Results were determined by HbA1c, presence of retinopathy and microalbuminuria. Both morphological and functional capillary changes were found in the participants. Three participants had microalbuminuria and one had early signs of retinopathy. Decreased baseline perfusion was associated with an increased number of microaneurysms.
 
In conclusion, this study found that microvascular complications in type 1 diabetics may be detected earlier by newer, non-invasive techniques.
 
Practice Pearls:
  • Diabetic patients with early signs of nephropathy should keep a close eye on blood pressure and glucose levels.
  • A great deal of impotence in diabetic men is largely due to neuropathy; neuropathy is also the most common complication of diabetes.
  • Diabetic foot disease is one of the most costly complications of diabetes.
Hosking S, Bhatia R, Crock P, et al. Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes. Diabetes/Cardiovascular Research & Reviews Feb.2014