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Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes: a pilot cross-sectional study.

Hosking SP, Bhatia R, Crock PA, Wright I, Squance ML, Reeves G - BMC Endocr Disord (2013)

Bottom Line: Fisher's exact and t-tests determined the association with clinical findings. 26 participants were recruited.Three participants had microalbuminuria and one had early signs of retinopathy.Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03).

View Article: PubMed Central - HTML - PubMed

Affiliation: John Hunter Children's Hospital, New Lambton, NSW 2305, Australia. sarahhosking14@gmail.com.

ABSTRACT

Background: The detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes.

Methods: Patients aged between 8 - 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher's exact and t-tests determined the association with clinical findings.

Results: 26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy.

Conclusions: This pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes.

Trial registration: Clinical Trial number NCT01279928, ClinicalTrials.gov.

No MeSH data available.


Related in: MedlinePlus

Nailfold capillaroscopy image assessing tool. Scoring scale developed by the authors, based on EULAR (European League Against Rheumatism) Guidelines (2008) [17]. Each nailfold image was divided into 4 consecutive 1 mm fields, which were analysed for nailfold abnormalities including: giant capillaries, capillary density, neoangiogenic capillaries, haemorrhages, morphology, presence of microaneurysms, avascular areas and the dominant capillary shape. The score was the average of each assessors abnormality count, for each nailfold.
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Figure 2: Nailfold capillaroscopy image assessing tool. Scoring scale developed by the authors, based on EULAR (European League Against Rheumatism) Guidelines (2008) [17]. Each nailfold image was divided into 4 consecutive 1 mm fields, which were analysed for nailfold abnormalities including: giant capillaries, capillary density, neoangiogenic capillaries, haemorrhages, morphology, presence of microaneurysms, avascular areas and the dominant capillary shape. The score was the average of each assessors abnormality count, for each nailfold.

Mentions: The presence of morphological features - including giant capillaries, capillary density, neoangiogenic capillaries, micro-haemorrhages, micro-aneurysms and avascular regions - was assessed by the capillaroscope technician and two immunologists, who were blinded to the clinical history of each participant. The analysis determined the presence and number of each abnormality, and calculated the capillary density from each nailfold image (see Figure 2). An average score for each abnormality was calculated from the three assessors scores of four individual nailfolds.


Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes: a pilot cross-sectional study.

Hosking SP, Bhatia R, Crock PA, Wright I, Squance ML, Reeves G - BMC Endocr Disord (2013)

Nailfold capillaroscopy image assessing tool. Scoring scale developed by the authors, based on EULAR (European League Against Rheumatism) Guidelines (2008) [17]. Each nailfold image was divided into 4 consecutive 1 mm fields, which were analysed for nailfold abnormalities including: giant capillaries, capillary density, neoangiogenic capillaries, haemorrhages, morphology, presence of microaneurysms, avascular areas and the dominant capillary shape. The score was the average of each assessors abnormality count, for each nailfold.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852758&req=5

Figure 2: Nailfold capillaroscopy image assessing tool. Scoring scale developed by the authors, based on EULAR (European League Against Rheumatism) Guidelines (2008) [17]. Each nailfold image was divided into 4 consecutive 1 mm fields, which were analysed for nailfold abnormalities including: giant capillaries, capillary density, neoangiogenic capillaries, haemorrhages, morphology, presence of microaneurysms, avascular areas and the dominant capillary shape. The score was the average of each assessors abnormality count, for each nailfold.
Mentions: The presence of morphological features - including giant capillaries, capillary density, neoangiogenic capillaries, micro-haemorrhages, micro-aneurysms and avascular regions - was assessed by the capillaroscope technician and two immunologists, who were blinded to the clinical history of each participant. The analysis determined the presence and number of each abnormality, and calculated the capillary density from each nailfold image (see Figure 2). An average score for each abnormality was calculated from the three assessors scores of four individual nailfolds.

Bottom Line: Fisher's exact and t-tests determined the association with clinical findings. 26 participants were recruited.Three participants had microalbuminuria and one had early signs of retinopathy.Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03).

View Article: PubMed Central - HTML - PubMed

Affiliation: John Hunter Children's Hospital, New Lambton, NSW 2305, Australia. sarahhosking14@gmail.com.

ABSTRACT

Background: The detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes.

Methods: Patients aged between 8 - 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher's exact and t-tests determined the association with clinical findings.

Results: 26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy.

Conclusions: This pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes.

Trial registration: Clinical Trial number NCT01279928, ClinicalTrials.gov.

No MeSH data available.


Related in: MedlinePlus