Assessment of biomarkers of inflammation and premature atherosclerosis in adolescents with type-1 diabetes mellitus

Type-1 diabetes mellitus (T1DM) causes endothelial dysfunction and early atherosclerosis, which can result in premature coronary artery disease. The aim of this study was to determine the impact of glycemic control, vascular oxidative stress and inflammation on vascular health in adolescents with T1DM. This was a cross-sectional study in adolescents with age- A nd sex-matched T1DM who were ≥12 years and were at least 2 years post-diagnosis. Recruitment was balanced to include individuals with hemoglobin A _1c (HbA _1c ) ≤8.5% (n=27) or with HbA _1c ≥9.5% (n=25). Biomarkers of inflammation were measured in the blood including C-reactive protein (CRP), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), E-selectin, fibrinogen and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and peripheral arterial tonometry (PAT) were assessed. Plasma E-selectin level was significantly different between the two groups with higher levels in the group with HbA _1c ≥9.5% (65.0±27.7 ng/mL vs. 48.8±21.5 ng/mL, p=0.02). Though cIMT and PAT were not significantly different between the groups, Pearson correlation showed a significant direct relationship between rising HbA _1c and mean right cIMT (p=0.02; r=0.37), PAT (p=0.03, r=0.31) and fibrinogen (p=0.03, r=0.03). Elevated E-selectin level is an early marker of oxidative stress in T1DM patients with an elevated HbA _1c level. Suboptimal glycemic control as evidenced by a rising HbA _1c causes early atherosclerosis.