JDM  Vol.7 No.3 , August 2017
Identification of Atherosclerotic Changes Using B-Mode Ultrasonography in Nigerian Children with Type 1 Diabetes Mellitus
ABSTRACT
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.
Cite this paper
Ayoola, O. , Elusiyan, J. and Adedeji, T. (2017) Identification of Atherosclerotic Changes Using B-Mode Ultrasonography in Nigerian Children with Type 1 Diabetes Mellitus. Journal of Diabetes Mellitus, 7, 142-150. doi: 10.4236/jdm.2017.73011.
References
[1]   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.

[2]   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

[3]   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

[4]   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

[5]   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

[6]   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

[7]   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

[8]   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

[9]   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.

[10]   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

[11]   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

[12]   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.

[13]   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

[14]   Ross, E. (1999) Atherosclerosis: An Inflammatory Disease. The New England Journal of Medicine, 340, 115-126.
https://doi.org/10.1056/NEJM199901143400207

[15]   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.

[16]   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.

[17]   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

[18]   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

[19]   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

[20]   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.

[21]   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.

[22]   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

[23]   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.

[24]   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

[25]   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

[26]   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

[27]   Yeboah, J., Crouse, J.R., Hsu, F., Burke, G.L. and Herrington, D.M. (2007) Brachial Flow-Mediated Dilation Predicts Incident Cardiovascular Events in Older Adults. Circulation, 115, 2390-2397.
https://doi.org/10.1161/CIRCULATIONAHA.106.678276

[28]   Vilaseca, M.A., Moyano, D., Ferrer, I. and Artuch, R. (1997) Total Homocysteine in Pediatric Patients. Clinical Chemistry, 4, 690-692.

[29]   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

[30]   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

[31]   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

[32]   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

 
 
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