Children with Well-Managed Type 1 Diabetes Show Arterial Changes: Research Stresses Early Intervention

The authors emphasized that maintaining normoglycemia is crucial for cardiovascular prevention in children with type 1 diabetes, alongside early monitoring and potential pharmaceutical intervention for hypertension and hyperlipidemia. They highlighted the need for sensitive methods to detect and evaluate vascular changes over time, particularly in well-controlled pediatric diabetes populations like the study cohort.

The researchers note that cardiovascular complications remain a major concern in type 1 diabetes, with early atherosclerosis linked to hyperglycemia, hypertension, and dyslipidemia. Despite advances in diabetes management, children with type 1 diabetes continue to exhibit modifiable cardiovascular risk factors, highlighting the need for individualized prevention strategies.

To address this, Ebba Bergdahl, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, and colleagues used ultra-high-frequency ultrasound (UHFUS) to detect subtle vascular changes in children with well-regulated diabetes, aiming to explore associations with glycemic and metabolic markers for early intervention.

For this purpose, the researchers conducted a cross-sectional case-control study at Queen Silvia Children's Hospital, Gothenburg, Sweden, involving children with type 1 diabetes (CWD) aged 6–15.99 years with a diabetes duration of at least five years. Age- and sex-matched healthy controls were included for comparison. Participants with other medical conditions, treatments beyond insulin, abnormal findings, or difficulty undergoing examinations were excluded. UHFUS assessed the radial, dorsal pedal, and carotid arteries. Blood samples, blood pressure, BMI z-scores, and glucometrics were collected to evaluate vascular changes and metabolic markers.

Based on the study, the researchers reported the following findings:

• The study was conducted from February 25, 2019, to June 28, 2022, and included 50 children with diabetes (CWD) and 41 healthy controls. After exclusions, data analysis included 45 CWD (22 girls, 23 boys; mean age 12.0 years) and 37 healthy controls (19 girls, 18 boys; mean age 11.3 years).
• CWD had a mean HbA1c of 6.6% (48.1 mmol/mol).
• There were higher diastolic blood pressure (DBP) z-scores in CWD.
• CWD had significantly increased dorsal pedal (DP) intima thickness (IT), DP intima-media thickness (IMT), and radial IT compared to controls.
• In CWD, carotid IT was negatively correlated with time in range (r = −0.47) and time in tight range (r = −0.64), while it was positively correlated with glucose variability (r = 0.40).
• Time in tight range and longitudinal HbA1c were the strongest determinants for carotid IT in CWD.
• Type 1 diabetes diagnosis was the strongest determinant of IT across all arteries.

The researchers found that children with well-regulated type 1 diabetes exhibit early vascular changes in the radial and dorsal pedal arteries. Regression analyses highlighted strong associations between intima thickness and hyperglycemia and type 1 diabetes diagnosis, suggesting that structural arterial changes originate in the intima.

"Their findings reinforce the importance of maintaining normoglycemia to prevent cardiovascular complications. We emphasize the need for larger studies to validate these results and further explore their clinical implications," the researchers concluded.

Reference:

Bergdahl, E., Forsander, G., Sundberg, F., Milkovic, L., & Dangardt, F. (2025). Investigating the presence and detectability of structural peripheral arterial changes in children with well-regulated type 1 diabetes versus healthy controls using ultra-high frequency ultrasound: A single-centre cross-sectional and case-control study. EClinicalMedicine, 81, 103097. https://doi.org/10.1016/j.eclinm.2025.103097