assessment of microvascular function in children and adolescents with diabetes and obesity

Background: endothelial dysfunction (ed) is a marker of vascular damage. glycated hemoglobin (a1c) predicts vascular complications. the endopat (peripheral arterial tonometry) device calculates the reactive hyperemic index (rhi), a measure of endothelial function. the greater the vasodilation, the higher the rhi. we hypothesized that children with poorly-controlled diabetes mellitus (dm) and non-diabetes mellitus (ndm) obese children have ed. methods: a cross-sectional study using the endopat device was performed on children with poorly-controlled dm and ndm children. anova, t-test, mann-whitney u test, multiple linear regression and spearman correlation were used. results: of 58 children that completed the study (aged 13.1 ± 3.42 years), 33 with type 1 diabetes (t1dm), 8 with type 2 diabetes (t2dm) and 17 were ndm obese children. eighty-five percent were african-american, 60% were female and 79% entered puberty. the rhi of children with dm (1.42 ± 0.48) versus ndm obese group (1.40 ± 0.34) was not different (p = 0.86) regardless of the type of dm or body mass index. in the dm group, for every 1% increase in latest a1c, the rhi decreased by 0.097 (p = 0.01) after adjusting for age, gender, and type of dm. the rhi of dm patients with latest a1c of < 10% (1.70 ± 0.58) versus those with a1c ≥10% (1.21 ± 0.19) was statistically different (p = 0.02). in the total study population, males had significantly lower rhi (1.28 ± 0.36) when compared to females (1.51 ± 0.46), p = 0.04 but this difference disappeared when considering pubertal status and type of diabetes. conclusions: our data showed that patients with poorly-controlled dm as reflected by latest a1c of ≥ 10% had worse endothelial function as reflected by lower rhi score.