Impaired skin microcirculation in paediatric patients with type 1 diabetes mellitusReportar como inadecuado

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Cardiovascular Diabetology

, 12:115

First Online: 12 August 2013Received: 17 May 2013Accepted: 12 August 2013


Aims-hypothesisWe used Laser Doppler Fluximetry LDF to define -normal- endothelial function in a large cohort of healthy children and adolescents and to evaluate skin microcirculation in paediatric patients with type 1 diabetes mellitus.

MethodsLDF was performed in 102 healthy children 12.8 ± 3.3 years of age; 48 male and 68 patients 12.9 ± 3.3 years of age; 33 male. Duration of disease was 5.0 ± 3.97 years. Each participant sequentially underwent three stimulation protocols localized thermal hyperaemia with localized warming to maximum 40°C, iontophoretic delivery of pilocarpine hydrochloride PCH and sodium nitroprusside SNP. The maximum relative increase in skin blood flow and the total relative response, i.e. the area under the curve AUC to each stimulus AUCheat, AUCPCH, AUCSNP was determined. In addition, the area of a right-angled triangle summarizing the time to and the amplitude of the first peak, which represents the axon reflex mediated neurogenic vasodilation ARR was calculated.

ResultsIn healthy controls, AUCheat, AUCPCH, AUCSNP, and ARR turned out to be independent of sex, age, and anthropometric values. Per parameter the 10th percentile generated from data of healthy controls was used as the lower threshold to define normal endothelial function. Diabetic patients showed significantly reduced vasodilatative response to either physical or pharmacological stimulation with SNP, whereas the response to PCH was comparable in both cohorts. In patients compared to controls i a significantly higher frequency of impaired vasodilatation in response to heat and SNP was noted and ii vascular response was classified as pathological in more than one of the parameters with significantly higher frequency.

Conclusions-interpretationSkin microvascular endothelial dysfunction is already present in about 25% of paediatric type 1 diabetic patients suffering from type 1 diabetes for at least one year. Future studies are needed to assess the predictive value of endothelial dysfunction in the development of long-term cardiovascular comorbidity in these patients.

KeywordsChildren Laser Doppler Fluximetry Skin microcirculation Type 1 diabetes mellitus AbbreviationsARRAxon Reflex Response

aPUArbitrary perfusion units

cIMTCarotid intima-media thickness

PCHPilocarpine hydrochloride

SkBFSkin blood flow

SDSStandard deviation score

SNPSodium nitroprusside.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2840-12-115 contains supplementary material, which is available to authorized users.

Dieter Haffner and Dagmar-C Fischer contributed equally to this work.

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Autor: Mirjam Heimhalt-El Hamriti - Corinna Schreiver - Anja Noerenberg - Julia Scheffler - Ulrike Jacoby - Dieter Haffner - Dagmar


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