The Effect of HbA1C Variability and Lipid Profile on Carotid Intima-Media Thickness (cIMT) and Flow-mediated Dilatation (FMD) in children and adolescent with Type 1 Diabetes Mellitus at Saiful Anwar Hospital Malang
DOI:
https://doi.org/10.21776/ub.hsj.2022.003.03.4Keywords:
HbA1c Variability, Lipid Profile, cIMT, FMD, Diabetes Mellitus type 1Abstract
Background
There is a correlation between diabetes mellitus type 1 (T1DM) and a higher risk of heart disease. Atherosclerosis, which can be discovered early with cIMT (Carotid Intima-Media Thickness) and Flow Mediated Dilation (FMD) tests, contributes to the development of cardiovascular disease. HbA1c fluctuation and lipid profile can have an impact on cIMT and FMD.
Aim
The aim of this study is to determine the influence of HbA1c variability and lipid profile on cIMT and FMD levels in children T1DM patients treated at Dr Saiful Anwar Hospital Malang.
Methods
The study utilized a cross-sectional design and included 82 participants with Type 1 Diabetes Mellitus who were routinely treated at the Dr. Saiful Anwar Hospital Malang's pediatric outpatient clinic between January - July 2019 and December 2021 and-Â January 2022.
Results
The correlation test revealed no significant connection between HDL (Ï=-0,029; p=0,796), LDL (Ï=-0.213; p=0.055), TG (Ï= -0.179; p= 0.107), and total cholesterol (Ï=-0.182; p= 0.101). Association tests revealed a positive correlation between LDL (Ï=0,318; p=0,004) and total cholesterol (Ï=0,230; p=0,038) levels and IMT. The correlation coefficient between HbA1C variability and FMD as evaluated by HVS was -0.498 (Ï=0.000; p=0.05), as was the correlation coefficient between HbA1c-SD (Ï=-0.467; p=0.000) and HbA1c-CV (Ï=-0.400; p=0.000). Additionally, a significant positive connection was discovered between IMT and the value of HbA1c variability utilizing HVS (Ï=0.455; p=0.000), HbA1c-SD (Ï=0.434; p=0.000), and HbA1c-CV (Ï=0.325; p=0.003). The linear regression analysis revealed that the three variables with the greatest influence on FMD were HVS (R=0.398), LDL (R=0.316), and HbA1c-SD (R=0.293). HVS (R=0.468), LDL (R=0.268), and total cholesterol (R=0.198) were the three most impactful variables on IMT. It is known that the combination of lipid profile and HbA1c fluctuation contributes 25.1% to FMD using this model. Meanwhile, the lipid profile and HbA1c variability together accounted for 34.5% of the variance in IMT.
Conclusion
Variability in HbA1c and lipid profile (LDL and total cholesterol) can contribute to an increase in intima-media thickness and a decrease in brachial artery FMD in children with T1DM.
Â
Â
References
Kesehatan K. Pusat Data dan Informasi - Kementerian Kesehatan Republik Indonesia. Published 2020. Accessed March 29, 2022. https://pusdatin.kemkes.go.id/article/view/20111800001/diabetes-melitus.html
You WP, Henneberg M. Type 1 diabetes prevalence increasing globally and regionally: the role of natural selection and life expectancy at birth. BMJ open diabetes Res care. 2016;4(1). doi:10.1136/BMJDRC-2015-000161
IDAI. IDAI | Konsensus Nasional Pengelolaan Diabetes Tipe 1. Published 2013. Accessed March 29, 2022. https://www.idai.or.id/professional-resources/pedoman-konsensus/konsensus-nasional-pengelolaan-diabetes-tipe-1
Manjunath CN, Rawal JR, Irani PM, Madhu K. Atherogenic dyslipidemia. Indian J Endocrinol Metab. 2013;17(6):969. doi:10.4103/2230-8210.122600
Zhou Z, Sun B, Huang S, Zhu C, Bian M. Glycemic variability: adverse clinical outcomes and how to improve it? Cardiovasc Diabetol. 2020;19(1):1-14. doi:10.1186/S12933-020-01085-6/FIGURES/2
Hoffman RP, Dye AS, Huang H, Bauer JA. Glycemic variability predicts inflammation in adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2016;29(10):1129-1133. doi:10.1515/JPEM-2016-0139/MACHINEREADABLECITATION/RIS
Ceriello A, Monnier L, Owens D. Glycaemic variability in diabetes: clinical and therapeutic implications. lancet Diabetes Endocrinol. 2019;7(3):221-230. doi:10.1016/S2213-8587(18)30136-0
Papageorgiou N, Briasoulis A, Androulakis E, Tousoulis D. Imaging Subclinical Atherosclerosis: Where Do We Stand? Curr Cardiol Rev. 2017;13(1):47. doi:10.2174/1573403X12666160803095855
Martin-Orozco N, Chung Y, Chang SH, Wang YH, Dong C. Th17 cells promote pancreatic inflammation but only induce diabetes efficiently in lymphopenic hosts after conversion into Th1 cells. Eur J Immunol. 2009;39(1):216-224. doi:10.1002/EJI.200838475
Dalla Pozza R, Ehringer-Schetitska D, Fritsch P, Jokinen E, Petropoulos A, Oberhoffer R. Intima media thickness measurement in children: A statement from the Association for European Paediatric Cardiology (AEPC) Working Group on Cardiovascular Prevention endorsed by the Association for European Paediatric Cardiology. Atherosclerosis. 2015;238(2):380-387. doi:1
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).