Advanced glycation end products in children with type 1 diabetes and early reduced diastolic heart function

• Published in: BMC cardiovascular disorders Vol. 17; no. 1; p. 133
• Main Authors: Brunvand, Leif, Heier, Martin, Brunborg, Cathrine, Hanssen, Kristian F, Fugelseth, Drude, Stensaeth, Knut Haakon, Dahl-Jørgensen, Knut, Margeirsdottir, Hanna Dis
• Format: Journal Article
• Language: English
• Published: England BioMed Central 25.05.2017; BMC
• Subjects: Adolescent; Adolescents; Advanced glycosylation end products; Age Factors; Atherosclerosis; Biomarkers - blood; Biomechanical Phenomena; Blood Pressure; Body mass; Body Mass Index; Cardiomyopathy; Carotid arteries; Carotid artery; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - physiopathology; Carotid Intima-Media Thickness; Child; Children; Chromatography; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetic Cardiomyopathies - blood; Diabetic Cardiomyopathies - diagnostic imaging; Diabetic Cardiomyopathies - etiology; Diabetic Cardiomyopathies - physiopathology; Diastole; Doppler effect; Echocardiography, Doppler; Elastic Modulus; Female; Glycated Hemoglobin A - analysis; Glycation End Products, Advanced - blood; Glycosylation; Heart; Humans; Hypertension; Imidazoles - blood; Immunoassay; Logistic Models; Male; Mechanical properties; Media; Metabolism; Metabolites; Odds Ratio; Ornithine - analogs & derivatives; Ornithine - blood; Predictive Value of Tests; Proteins; Pyruvaldehyde; Regression analysis; Risk Factors; Serum levels; Statistics; Teenagers; Ultrasonic imaging; Ultrasound; Up-Regulation; Vascular Stiffness; Veins & arteries; Velocity; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Right - blood; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Left; Ventricular Function, Right; Xenografts
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-017-0551-0

Reduced diastolic function is an early sign of diabetes cardiomyopathy in adults and is associated with elevated levels of HbA1c and advanced glycation end products (AGEs). To assess the associations between early reduced diastolic function and elevated levels of HbA1c and AGEs in children and adolescents with type 1 diabetes (T1D). One hundred fourty six T1D patients (age 8-18 years) without known diabetic complications were examined with tissue Doppler imaging and stratified into two groups according to diastolic function. A clinical examination and ultrasound of the common carotid arteries were performed. Methylglyoxal-derived hydroimidazolone-1 (MG-H1) was measured by immunoassay. At inclusion, 36 (25%) participants were stratified into a low diastolic function group (E'/A'-ratio < 2.0). Compared to the rest of the T1D children, these participants had higher body mass index (BMI), 22.8 (SD = 4.0) vs. 20.1 (SD = 3.4) kg/m , p < 0.001, higher systolic blood pressure 104.2 (SD = 8.7) vs. 99.7 (SD = 9.3) mmHg, p = 0.010, and higher diastolic blood pressure, 63.6 (SD = 8.3) vs. 59.9 (SD = 7.9) mmHg, p = 0.016. The distensibility coefficient was lower, 0.035 (SD = 0.010) vs. 0.042 (SD = 0.02) kPa , p = 0.013, Young's modulus higher, 429 (SD = 106) vs. 365 (SD = 143), p = 0.009, and MG-H1 higher, 163.9 (SD = 39.2) vs. 150.3 (SD = 33.4) U/ml, p = 0.046. There was no difference in carotid intima-media thickness between the groups. There were no associations between reduced diastolic function and years from diagnosis, HBA1c, mean HBA1c, CRP or calculated glycemic burden. Logistic regression analysis showed that BMI was an independent risk factor for E'/A'-ratio as well as a non-significant, but relatively large effect size for MG-H1, indicating a possible role for AGEs. Early signs of reduced diastolic function in children and adolescents with T1D had higher BMI, but not higher HbA1c. They also had elevated serum levels of the advanced glycation end product MG-H1, higher blood pressure and increased stiffness of the common carotid artery, but these associations did not reach statistical significance when tested in a logistic regression model.