Background : This study aimed at documenting the degree of atherosclerosis, which is an important macrovascular complication in Nigerian children with Type 1 Diabetes Mellitus as determined by ultrasonography using the carotid, femoral and brachial arteries. Method : A prospective observational study was performed on all 10 children diagnosed with diabetes mellitus at the paediatric endocrinology clinic, in a tertiary unit based in Nigeria over a six-month period. Results : All 10 children were aged between 12 - 17 years (Median = 16 years) and consist of 5 (50%) males and 5 (50%) female. The duration of diabetes ranged from 0.2 to 9 years. Four (40%) of the subjects had thickened carotid intima media thickness on either the left or right common carotid artery; 5 (50%) had 0% flow mediated dilation of the brachial artery while the remaining 5 (50%) had normal flow mediated dilation; while 2 (30%) had intima media thickening of either the left or right superficial femoral artery using a cut-off value of 0.9 cm. Conclusion : Children with Type 1 Diabetes Mellitus have ultrasonic evidence of ongoing atherosclerosis. The use of ultrasound is recommended for detection and monitoring of atherosclerotic changes in children with DM.
Nokoff, N.J., Rewers, M. and Cree Green, M. (2012) The Interplay of Autoimmunity and Insulin Resistance in Type1 Diabetes. Discovery Medicine, 13, 115-122.
Nokoff, N.J. and Rewers, M. (2013) Pathogenesis of Type 1 Diabetes: Lessons from Natural History Studies of High Risk Individuals. Annals of the New York Academy of Sciences, 1281, 1-5. https://doi.org/10.1111/nyas.12021
Soedamah-Muthu, S.S., Fuller, J.H., Mulnier, H.E., Raleigh, V.S., Lawrenson, R.A. and Colhoun, H.M. (2006) High Risk of Cardiovascular Disease in Patients with Type 1 Diabetes in the UK: A Cohort Study Using the General Practice Research Database. Diabetes Care, 29, 798-804. https://doi.org/10.2337/diacare.29.04.06.dc05-1433
Loomans, C.J., de Koning, E.J., Staal, F.J., Rookmaaker, M.B., Verseyden, C., de Boer, H.C., et al. (2004) Endothelial Progenitor Cell Dysfunction. Diabetes, 53, 195-199. https://doi.org/10.2337/diabetes.53.1.195
Swerdlow, A.J. and Jones, M.E. (1996) Mortality during 25 Years of Follow-Up of a Cohort with Diabetes. International Journal of Epidemiology, 25, 1250-1261. https://doi.org/10.1093/ije/25.6.1250
Makinen, V., Forsblom, C., Thorn, L. and Waden, J. (2008) Metabolic Phenotypes, Vascular Complications, and Premature Deaths in a Population of 4,197 Patients with Type 1 Diabetes. Diabetes, 57, 2480-2487. https://doi.org/10.2337/db08-0332
Hayaishi-Okano, R., Yamasaki, Y., Katakami, N., Ohtoshi, K., Gorogawa, S.I., Kuroda, A., et al. (2002) Elevated C-Reactive Protein Associates with Early-Stage Carotid Atherosclerosis in Young Subjects with Type 1 Diabetes. Diabetes Care, 25, 1432-1438. https://doi.org/10.2337/diacare.25.8.1432
Bots, M.L., Westerink, J., Rabelink, T.J. and de Koning, E.J. (2005) Assessment of Flow-Mediated Vasodilation (FMD) of the Brachial Artery: Effects of Technical Aspects of the FMD Measurement on the FMD Response. European Heart Journal, 26, 363-368. https://doi.org/10.1093/eurheartj/ehi017
Bernetti, M., Abbate, R., Cerini, G., Gensini, G.F., Poggesi, L. and Boddi, M. (2011) Carotid and Femoral Intima-Media Thickness as an Early Atherosclerotic Marker. Advantages and Limits. Giornale Italiano di Cardiologia, 12, 72-81.
Allan, P.L., Mowbray, P.I., Lee, A.J. and Fowkes, F.G. (1997) Relationship between Carotid Intima-Media Thickness and Symptomatic and Asymptomatic Peripheral Arterial Disease. The Edinburgh Artery Study. Stroke, 28, 348-353. https://doi.org/10.1161/01.STR.28.2.348
Grobbee, D.E. and Bots, M.L. (1994) Carotid Artery Intima-Media Thickness as an Ultrasound Indicator of Generalized Atherosclerosis. Journal of Internal Medicine, 236, 567-573. https://doi.org/10.1111/j.1365-2796.1994.tb00847.x
Kazmierski, R., Kozubski, W. and Watala, C. (2000) Intima-Media Complex Thickness of Common Carotid Artery as a Risk Factor for Stroke. Neurologia i Neurochirurgia Polska, 34, 243-253.
Suurkula, M., Fagerberg, B., Wendelhag, I., Agewall, S. and Wikstrand, J. (1996) Atherosclerotic Disease in the Femoral Artery in Hypertensive Patients at High Cardiovascular Risk. The Value of Ultrasonographic Assessment of Intima-Media Thickness and Plaque Occurrence. Risk Intervention Study (RIS) Group. Arteriosclerosis, Thrombosis, and Vascular Biology, 16, 971-977. https://doi.org/10.1161/01.ATV.16.8.971
Ross, E. (1999) Atherosclerosis: An Inflammatory Disease. The New England Journal of Medicine, 340, 115-126. https://doi.org/10.1056/NEJM199901143400207
Widlanksy, M.E., Gokce, N., Keaney, J.F. and Vita, J.A. (2003) The Clinical Implications of Endothelial Dysfunction. Journal of the American College of Cardiology, 42, 1149-1160.
Celermajer, D.S., Sorensen, K.E. and Gooch, V.M. (1992) Non-Invasive Detection of Endothelial Dysfunction in Children and Adults at Risk of Atherosclerosis. The Lancet, 340, 1111-1115.
Harris, R.A., Nishiyama, S.K., Wray, D.W. and Richardson, R.S. (2010) Ultrasound Assessment of Flow-Mediated Dilation. Hypertension, 55, 1075-1085. https://doi.org/10.1161/HYPERTENSIONAHA.110.150821
Gómez-Díaz, R.A., Ramírez-Soriano, E., Tanus Hajj, J. and Bautista Cruz, E. (2012) Association between Carotid Intima-Media Thickness, Buccodental Status, and Glycemic Control in Pediatric Type 1 Diabetes. Pediatric Diabetes, 13, 552-558. https://doi.org/10.1111/j.1399-5448.2012.00868.x
Siró, P., Molnár, C., Katona, E., Antek, C. and Kollár, J. (2009) Carotid Intima-Media Thickness and Cerebrovascular Reactivity in Long-Term Type 1 Diabetes Mellitus. Journal of Clinical Ultrasound, 37, 451-456. https://doi.org/10.1002/jcu.20617
Majaliwa, E.S., Elusiyan, J.B.E., Adesiyun, O.O., Laigong, P., Adeniran, K.A., Kandi, M.C., et al. (2008) Type 1 Diabetes Mellitus in African Population: Epidemiology and Management Challenges. Acta Biomedica, 79, 255-259.
Elusiyan, J.B.E., Okeniyi, J.A.O. and Adegoke, S.A. (2008) Challenges of Managing Diabetes Mellitus in Nigerian Children. Nigerian Endocrine Practice, 2, 111-115.
Ngwiri, T., Were, F., Predieri, B., Ngugi, P. and Iughetti, L. (2015) Glycaemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus. International Journal of Endocrinology, 2015, Article ID: 761759. https://doi.org/10.1155/2015/761759
The Diabetic Control and Complications Trial Research Group (1993) The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long Term Complications in IDDM. The New England Journal of Medicine, 14, 977-986.
Ninomiya, T., Perkovic, V., de Galan, B.E., Zoungas, S., Pillai, A., Jardine, M., et al. (2009) Albuminuria and Kidney Function Independently Predict Cardiovascular and Renal Outcomes in Diabetes. Journal of the American Society of Nephrology, 20, 1813-1821. https://doi.org/10.1681/ASN.2008121270
Pignoli, P., Tremoli, E., Poli, A., Oreste, P. and Paoletti, R. (1986) Intima plus Medial Thickness of the Arterial Wall: A Direct Measurement with Ultrasound Imaging. Circulation, 74, 1399-1406. https://doi.org/10.1161/01.CIR.74.6.1399
Held, C., Hjemdahl, P., Eriksson, S.V., Bjorkander, I., Forslund, L. and Rehnqvist, N. (2001) Prognostic Implications of Intima-Media Thickness and Plaques in the Carotid and Femoral Arteries in Patients with Stable Angina Pectoris. European Heart Journal, 22, 62-72. https://doi.org/10.1053/euhj.1999.2006
Vilaseca, M.A., Moyano, D., Ferrer, I. and Artuch, R. (1997) Total Homocysteine in Pediatric Patients. Clinical Chemistry, 4, 690-692.
Colwell, J.A., Lopes-virella, M. and Halushka, P.V. (1981) Pathogenesis of Atherosclerosis in Diabetes Mellitus. Diabetes Care, 4, 121-133. https://doi.org/10.2337/diacare.4.1.121
Davis, P.H., Dawson, J.D., Riley, W.A. and Lauer, R.M. (2001) Carotid Intimal-Medial Thickness Is Related to Cardiovascular Risk Factors Measured from Childhood through Middle Age: The Muscatine Study. Circulation, 104, 2815-2819. https://doi.org/10.1161/hc4601.099486
Ayoola, O.O., Onuwaje, M.A. and Akintomide, A.O. (2015) Sonographic Assessment of the Carotid Intima-Media Thickness on B-Mode Ultrasonography in a Nigerian Population. Nigerian Medical Journal, 56, 357-361. https://doi.org/10.4103/0300-1652.170384
Schalinske, K.L. (2003) Interrelationship between Diabetes and Homocysteine Metabolism: Hormonal Regulation of Cystathionine [beta]-Synthase. Nutrition Reviews, 61, 136. https://doi.org/10.1301/nr.2003.apr.136-138