Increased carotid intima–media thickness (CIMT) levels in patients with type 1 diabetes mellitus (T1DM): A meta-analysis
Introduction
Type 1 diabetes mellitus (T1DM) is also called insulin-dependent diabetes mellitus (IDDM), which is dependent on insulin therapy from beginning of T1DM and have to be used in the reminder of patients' life. Some epidemiological studies have demonstrated a rising incidence of T1DM worldwide in the past few decades. In European, children under 14 years, the incidence of T1DM increased on average by 3.2% per year (Schwab et al., 2007). Diabetes has long been recognized as an independent risk factor for coronary artery disease (CAD). T1DM is associated with an increased cardiovascular (CV) morbidity and mortality as compared with the general population (Distiller, Joffe, Brown, & Distiller, 2010). The morbidity and mortality due to coronary artery disease are two to four times greater than in healthy control subjects (Muis et al., 2005, Raggi et al., 2005). And cardiovascular disease is based on atherosclerosis (AS), the hallmark of cardiovascular diseases, which is the leading cause of mortality all over the world. Many studies reported that patients with diabetes have 2 to 10 times increased risk of developing atherosclerotic disease (Atabek et al., 2014, Lee et al., 2011, Pozza et al., 2010, Tantawy et al., 2009). Carotid intima–media thickness (CIMT) level is the symbol of early atherosclerosis, it has been shown to be the marker of preclinical atherosclerosis (Gimenez et al., 2010), and measurement of the CIMT is independently associated with an increased cardiovascular disease (Atabek, Pirgon, Kurtoglu, & Imamoglu, 2006). Noninvasive surrogate markers of early atherosclerosis should be used to allow the early detection of atherosclerosis before leading to disease. High-resolution ultrasonographic measurement of the CIMT is one such method (Larsen et al., 2005, Tyrrell et al., 2010).
In recent years, a great many studies have been performed to compare the mean CIMT difference between patients with T1DM and healthy controls. However, these studies have shown inconsistent or even contradictory findings. The inconsistency is likely due to different publication years, nations, composition of age and sex, disease duration of patients, publication bias, etc. This meta-analysis was undertaken to derive a more precise estimation of the difference in CIMT between T1DM patients and control subjects.
Section snippets
Search and review strategy
A systematic search was conducted in the PubMed and Embase databases by computer to search the literatures that related to CIMT and T1DM. The English literatures were identified. Literature search was performed using the terms: “carotid intima–media thickness” and “CIMT” combined with the following keywords: “autoimmune disease”, “autoimmunity”, “type 1 diabetes mellitus”, “diabetes mellitus type 1”, “type 1 diabetes” and “T1DM”. The references in the reviewed articles were manually scanned for
Studies and subjects
Literature reviewing resulted in 1840 potential articles and 47 articles were included into this study eventually (Abdelghaffar et al., 2006, Adly et al., 2014, Aguilera et al., 2012, Atwa and Shora, 2011, Atwa et al., 2011, Babar et al., 2011, Ciftel et al., 2014, Dalla Pozza et al., 2007, Dogansen et al., 2013, Duca et al., 2013, El Samahy et al., 2012, Faienza et al., 2013, Gimenez et al., 2011, Glowinska-Olszewska et al., 2007, Goksen et al., 2013, Gul et al., 2010, Gunczler et al., 2002,
Discussion
Atherosclerosis is one of the most important and severe cardiovascular complications in diabetes patients. Because the carotid arteries are the most commonly involved part in early atherosclerosis, CIMT is affected by cardiovascular risk factors that occur with greater frequency in the T1DM patients compared to age-matched control subjects (Chahal et al., 2012). In addition, because the position of carotid arteries is shallow, the value of CIMT by ultrasonic testing can be used as a surrogate
Conclusions
In summary, T1DM is associated with higher CIMT, supporting the current evidence base for an increased CV burden in this population. However, in order to obtain more accurate and reliable conclusion, large-scale prospective studies should be carried out.
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Dietary quality and carotid intima media thickness in type 1 and type 2 diabetes: Follow-up of a randomised controlled trial
2018, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Carotid IMT measured using B mode ultrasound is an early marker of atherosclerosis [9] and a predictor of CVD [10]. Type 1 and type 2 diabetes are associated with greater carotid IMT compared to non-diabetic subjects [11–13]. In a recent meta-analysis of 47 studies, Sun et al. reported that people with type 1 diabetes had higher carotid IMT levels (standardized mean difference: 1.01, 95% CI: 0.75–1.28; P < 0.001) compared to controls without diabetes [12].
Cardiac autonomic neuropathy may play a role in pathogenesis of atherosclerosis in type 1 diabetes mellitus
2017, Diabetes Research and Clinical PracticeCitation Excerpt :The meta-analysis of Sun et al. [21] from 2015 showed that patients with type 1 diabetes mellitus have higher carotid intima-media thickness in comparison to the non-diabetic population, which is in correlation with our results. An increased CIMT level in T1DM patients may demonstrate a higher risk of cardiovascular events [21]. Macro-vascular complications are the main cause of morbidity and mortality in diabetes mellitus patients [22].
Conflict of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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Yi-Peng Sun and Yuan-Yuan Cai contributed equally to this work and should be considered co-first authors.