Significance of determination of hemodynamic phenotypes in early diagnosis of cardiovascular disorders in children with diabetes mellitus
DOI:
https://doi.org/10.14739/2310-1237.2021.2.217936Keywords:
diabetes mellitus, adolescent, hemodynamics, сardiovascular systemAbstract
Aim. To stratify hemodynamic phenotypes in children with diabetes mellitus and their frequency, depending on the duration of the disease.
Materials and methods. The study involved 72 children suffering from diabetes, aged 10 to 16 years who were divided into 3 groups. The first group – 22 children with diabetes mellitus up to 1 year. The second group – 24 patients with a disease duration of 1 to 5 years. The third group – 26 children with the disease over 5 years. Control group – 20 children, representative by age and sex.
All children underwent daily blood pressure monitoring (ABPM) with the ABPM-04 device (Meditech Ltd, Hungary). Diagnosis of latent hemodynamic disorders was performed by the method of quantitative analysis of the relationships of blood pressure parameters, which involved a linear regression of systolic blood pressure by pulse blood pressure. According to the results of regression, 6 hemodynamic phenotypes were determined, which characterized the individual features of the circulatory system: harmonic, myocardial-insufficient subtype of harmonic, borderline diastolic harmonic, borderline systolic harmonic, dysfunctional diastolic and dysfunctional systolic. According to ABPM results, the ambulatory arterial stiffness index (AASI) was calculated using a linear regression equation. The results were statistically processed using statistics software package Statistica 13.0 (StatSoft Inc., No. JPZ8041382130ARCN10-J).
Results. It was found that in the dynamics of diabetes the registration of the harmonic hemodynamic phenotype during the day decreased due to an increase in the proportion of patients with dysfunctional diastolic hemodynamic phenotype. At the same time, in children with diabetes, there was a significant increase in AASI from the first year of the disease with a progressive increase with its dynamics. The highest values of AASI were observed in dysfunctional hemodynamic phenotype.
Conclusions. In children with diabetes mellitus observed the formation of disharmonious hemodynamic phenotypes in the dynamics of the disease. In combination with increased vascular stiffness these changes realized in systemic circulatory disorders and the development of a diabetic angiopathy. Detected disorders, apparently, became the risk factors of hypertension. Determination of hemodynamic phenotype in children with diabetes mellitus can be used as screening method for preclinical diagnosis of latent disorders of the cardiovascular system, early treatment and prevention.
References
Delyagin, V. M., Urazbagambetov, A., Korolev, A. V., Kilikovsky, V. V., & Olimpieva, S. P. (2014). Indeks zhestkosti arterial'noi stenki v traktovke rezul'tatov sutochnogo monitorirovaniya arterial'nogo davleniya [Arterial wall stiffness index in interpretation of the results of ambulatory blood pressure monitoring]. Detskaya bol'nitsa, (1), 17-22. [in Russian].
Zelinska, N. B., Rudenko, N. G., Globa, E. V., Shevchenko, І. Yu., & Kavetska, Yu. S. (2019). Dytiacha endokrynolohiia v Ukraini u 2018 rotsi [Pediatric endocrinology in Ukraine in 2018]. Ukrainskyi zhurnal dytiachoi endokrynolohii, (1), 7-15. [in Ukrainian]. https://doi.org/10.30978/UJPE2019-1-7
Khursa, R. V. (2015). Latentnye narusheniya krovoobrashcheniya u molodykh lyudei i ikh korrektsiya pri modifikatsii obraza zhizni s vklyucheniem fizicheskikh nagruzok [Latent circulatory disorders in young people and their correction during lifestyle modification with the inclusion of physical activity]. In K. Yu. Romanov, E. S. Vand (Eds.), Ozdorovitel'naya fizicheskaya kul'tura molodezhi: aktual'nye problemy i perspektivy. Proceedings of the 2nd International Scientific and Practical Conference (pp. 131-136). Minsk: BSMU. [in Russian].
Khursa, R. V., & Zabela, Ye. I. (2019). Gemodinamicheskie fenotipy u prakticheski zdorovykh molodykh lyudei s raznym urovnem fizicheskoi podgotovki [Hemodynamic phenotypes in healthy young people with differernt levels of physical training]. Voennaya meditsina, (3), 112-117. [in Russian].
Khursa, R. V., Mesnikova, I. L., Eremina, N. M., & Voitikova, M. V. (2018). Metod opredeleniya gemodinamicheskogo fenotipa [Method for determining the hemodynamic phenotype]. Minsk: BSMU. [in Russian].
Tseluiko, V. I., Bregvadze, T. R., & Mishchuk, N. Ye. (2012). Faktory, assotsiirovannye s pokazatelyami tsentral'nogo aortal'nogo davleniya u bol'nykh s arterial'noi gipertenziei [Factors associated with central aortic pressure parameters in patients with arterial hypertension]. Ukrainskyi kardiolohichnyi zhurnal, (10), 58-66. [in Russian].
Khunti, K., Davies, M., Majeed, A., Thorsted, B. L., Wolden, M. L., & Paul, S. K. (2015). Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes care, 38(2), 316-322. https://doi.org/10.2337/dc14-0920
Muxfeldt, E. S., Cardoso, C. R., Dias, V. B., Nascimento, A. C., & Salles, G. F. (2010). Prognostic impact of the ambulatory arterial stiffness index in resistant hypertension. Journal of hypertension, 28(7), 1547-1553. https://doi.org/10.1097/HJH.0b013e328339f9e5
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group (2016). Risk Factors for Cardiovascular Disease in Type 1 Diabetes. Diabetes, 65(5), 1370-1379. https://doi.org/10.2337/db15-1517
Schofield, J., Ho, J., Soran, H. (2019). Cardiovascular Risk in Type 1 Diabetes Mellitus. Diabetes therapy : research, treatment and education of diabetes and related disorders. 10(3), 773-789. https://doi.org/10.6084/m9.figshare.7901828
Simonetti, G. D., Von Vigier, R. O., Wühl, E., & Mohaupt, M. G. (2008). Ambulatory arterial stiffness index is increased in hypertensive childhood disease. Pediatric research, 64(3), 303-307. https://doi.org/10.1203/PDR.0b013e31817d9bc5
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
