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|Title:||Hypoglycemia, but Not Glucose Variability, Relates to Vascular Function in Children with Type 1 Diabetes|
|Author:||Pena Vargas, A.|
|Citation:||Diabetes Technology & Therapeutics, 2012; 14(6):457-462|
|Publisher:||Mary Ann Liebert, Inc Publishers|
|Alexia S. Peña, Jennifer J. Couper, Jennifer Harrington, Roger Gent, Jan Fairchild, Elaine Tham, and Peter Baghurst|
|Abstract:||<h4>Background</h4>Chronic sustained hyperglycemia unequivocally predicts vascular disease in diabetes. However, the vascular risk of glucose variability, including hypoglycemia, is uncertain. Vascular dysfunction is present in children with type 1 diabetes and is a critical precursor of atherosclerosis. We aimed to evaluate the relationship between glucose variability and vascular function in children with type 1 diabetes.<h4>Subjects and methods</h4>Fifty-two type 1 diabetes subjects (14 [SD 2.7] years old, 25 males) had continuous glucose monitoring that included 48 h of data used to evaluate glucose variability (mean amplitude of glycemic excursions [MAGE] and other measurements) and hypoglycemia indices (glycemic risk assessment diabetes equation [GRADE] hypoglycemia, Low Blood Glucose Index [LBGI], and observed duration of hypoglycemia). Children with type 1 diabetes and 50 age- and gender-matched controls had assessments of vascular function (flow-mediated dilatation [FMD] and glyceryl trinitrate-mediated dilatation [GTN]).<h4>Results</h4>Children with type 1 diabetes had lower FMD and GTN than controls (P=0.02 and P<0.001, respectively). GRADE hypoglycemia and LBGI were inversely related to FMD (r=-0.36, P=0.009 and r=-0.302, P=0.03, respectively) but did not relate to GTN. GRADE hypoglycemia was independently related to FMD (regression coefficient=-0.25±0.09, P=0.006). MAGE and other measurements of glucose variability measurements did not relate to FMD or GTN.<h4>Conclusions</h4>Hypoglycemia, but not glucose variability, during continuous glucose monitoring relates to impaired vascular endothelial function in children with type 1 diabetes. Hypoglycemia may be an additional risk factor for early cardiovascular disease, but the effect of glucose variability, independent of glycosylated hemoglobin, on vascular function remains uncertain.|
|Keywords:||Endothelium, Vascular; Humans; Diabetic Angiopathies; Diabetes Mellitus, Type 1; Hypoglycemia; Blood Glucose; Hypoglycemic Agents; Risk Factors; Case-Control Studies; Age of Onset; Algorithms; Adolescent; Australia; Female; Male; Atherosclerosis; Glycated Hemoglobin A|
|Rights:||© Mary Ann Liebert, Inc.|
|Appears in Collections:||Paediatrics publications|
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