Chiesa, Scott; Benitez-Aguirre, Paul; Cameron, Fergus J; Craig, Maria; Couper, Jennifer J; Davis, Elizabeth A; Dalton, R Neil; ... Marcovecchio, M Loredana; + view all Chiesa, Scott; Benitez-Aguirre, Paul; Cameron, Fergus J; Craig, Maria; Couper, Jennifer J; Davis, Elizabeth A; Dalton, R Neil; Daneman, Denis; Donaghue, Kim C; Jones, Timothy J; Mahmud, Farid H; Marshall, Sally M; Neil, H Andrew; Deanfield, John E; Marcovecchio, M Loredana; - view fewer (2023) Adolescence is a time of accelerated vascular ageing in type 1 diabetes: initial findings from the AdDIT Follow-Up Study. Presented at: ISPAD 23, Rotterdam, Netherlands.

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Abstract

Introduction: Childhood-onset type 1 diabetes (T1D) is associated with an increased risk of premature cardiovascular mortality. / Objectives: This study aimed to assess the evolution of subclinical vascular damage in young people with T1D as they transitioned through adolescence. / Methods: Repeated vascular phenotyping was performed in early adolescence (age 13), late adolescence (age 17), and young adulthood (age 23) in 288 adolescents with T1D (52% male) recruited to the Adolescent Type 1 Diabetes Intervention Trial Follow-Up Study (AdDIT Follow-Up). Carotid remodelling was assessed via measures of lumen diameter, intima-media thickness (IMT), and beta stiffness index; aortic stiffness via carotid-femoral pulse wave velocity (PWV); and endothelial function via flow-mediated dilation (FMD). Repeated measures ANOVA were used to assess vascular changes over time, and unpaired t-tests used to compare vascular phenotypes measured in young adulthood to an age- and sex-matched group without T1D (n = 292; 49% male). / Results: In individuals with T1D, progressive stiffening of both the carotid artery and aorta was observed across the 9-year follow-up (e.g. PWV mean [95%CI] change = 1.1 [0.9, 1.3] m/s). In the transition from late adolescence to young adulthood, IMT also increased (+0.04 [0.03, 0.06] mm) and FMD decreased (-1.0 [-0.8, -1.2] %). As a result, young adults with T1D had carotid arteries that were narrower, thicker (IMT = +0.3 [0.2, 0.4] mm), and stiffer (beta stiffness index = +0.3 [0.1, 0.5]) than those without T1D. Aortic stiffness was also higher (PWV = +0.8 [0.6, 0.9] m/s) in T1D, while a compromised FMD (-2.8 [-2.0, -3.6]%) indicated the presence of systemic endothelial dysfunction. / Conclusions: Young people with T1D demonstrate accelerated arterial ageing as they transition adolescence. As a result, these individuals enter young adulthood with arteries that are already smaller, thicker, stiffer, and with evidence of profound endothelial dysfunction when compared to young adults without T1D.

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