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Exp Clin Endocrinol Diabetes 2022; 130(06): 415-422
DOI: 10.1055/a-1523-7574
Article

Vascular and Myocardial Function in Young People with Type 1 Diabetes Mellitus: Insulin Pump Therapy Versus Multiple Daily Injections Insulin Regimen

Maria Felicia Faienza
1   Department of Biomedical Sciences and Human Oncology, Pediatric Section, University “A.Moro”, Bari, Italy
,
Pietro Scicchitano
2   Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Bari, Italy
,
Raffaella Lamparelli
1   Department of Biomedical Sciences and Human Oncology, Pediatric Section, University “A.Moro”, Bari, Italy
,
Pierlugi Zaza
1   Department of Biomedical Sciences and Human Oncology, Pediatric Section, University “A.Moro”, Bari, Italy
,
Annagrazia Cecere
2   Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Bari, Italy
,
Giacomina Brunetti
3   Department of Biosciences, Biotechnologies and Biopharmaceutics, University “A. Moro” of Bari, Bari, Italy
,
Francesca Cortese
2   Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Bari, Italy
,
Federica Valente
2   Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Bari, Italy
,
Maurizio Delvecchio
4   Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
,
Paola Giordano
1   Department of Biomedical Sciences and Human Oncology, Pediatric Section, University “A.Moro”, Bari, Italy
,
Anna Paola Zito
2   Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Bari, Italy
,
Gabriele D’Amato‡
5   Department of Women’s and Children’s Health, ASL Bari, Neonatal Intensive Care Unit, “Di Venere” Hospital, Bari, Italy
,
Marco Matteo Ciccone‡
2   Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Bari, Italy
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Abstract

Introduction Multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) are two modalities of treating type 1 diabetes mellitus (T1DM). The benefits of CSII on long-term metabolic control and outcomes compared to those of MDI are still debated. We investigated both vascular function and myocardial performance in T1DM adolescents on MDI or CSII treatment.

Methods One hundred twenty-three T1DM subjects (mean age 14.16±2.55 years), 63 on MDI regimen, 60 on CSII, and 57 controls were enrolled. Anthropometric and biochemical characteristics were evaluated. Ultrasound assessments of carotid intima-media thickness (cIMT), flow-mediated dilatation of brachial artery, anteroposterior diameter of the infrarenal abdominal aorta (APAO), and transthoracic echocardiography were performed.

Results T1DM subjects on the CSII regimen showed better glycemic control than those on MDI, expressed as glycated haemoglobin (HbA1c). c-IMT and APAO were higher in MDI than CSII patients (0.61±0.11 mm vs. 0.56±0.07 mm, p=0.04; 13.61±3.29 mm vs. 11.65±1.84 mm, p=0.01, respectively). Left and right Tei index and left E/e’ ratio were higher in MDI than CSII subjects (0.82±0.40 vs. 0.52±0.19, p=0.002; 0.86±0.41 vs. 0.64±0.1, p=0.02; 5.89±2.0 vs. 4.73±1.59, p=0.02, respectively). Multiple regression analyses showed that glucose level, HbA1c and diabetes onset were significantly related to vascular and echocardiographic parameters in MDI and CSII patients.

Conclusions CSII regimen in T1DM adolescents improves glycemic control and seems to ameliorate endothelial function and global myocardial performance as compared to MDI therapy.

Key words

type 1 diabetes - CSII - MDI - endothelial function - myocardial performance


Publication History

Received: 25 February 2021
Received: 30 April 2021

Accepted: 28 May 2021

Article published online:
12 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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