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Type: Journal article
Title: Hypoglycemia, but Not Glucose Variability, Relates to Vascular Function in Children with Type 1 Diabetes
Author: Pena Vargas, A.
Couper, J.
Harrington, J.
Gent, R.
Fairchild, J.
Tham, E.
Baghurst, P.
Citation: Diabetes Technology and Therapeutics, 2012; 14(6):457-462
Publisher: Mary Ann Liebert, Inc Publishers
Issue Date: 2012
ISSN: 1520-9156
Statement of
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
Diabetic Angiopathies
Diabetes Mellitus, Type 1
Blood Glucose
Hypoglycemic Agents
Risk Factors
Case-Control Studies
Age of Onset
Glycated Hemoglobin A
Rights: © Mary Ann Liebert, Inc.
DOI: 10.1089/dia.2011.0229
Grant ID: NHMRC-519245
Appears in Collections:Aurora harvest 5
Paediatrics publications

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