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document
Intensive insulin therapy improves endothelial function and microvascular reactivity in young people with type 1 diabetes . AIMS/HYPOTHESIS Macrovascular disease is an important cause of the increased morbidity and mortality rates associated with type 1 diabetes , and this vascular impairment begins in childhood . The aim of this study was to determine whether introducing intensive diabetes management [ intensive insulin therapy ( IIT ) and 'Sweet Talk ' text-messaging support ] produces measurable improvements in endothelial function . METHODS One hundred and twenty-six patients fulfilled the eligibility criteria ( type 1 diabetes for > 1 year ; on conventional insulin therapy ( CIT ) ; aged between 8 and 18 years ) , of whom 92 enrolled . Patients were randomised to group 1 , CIT only ( n=28 ) ; group 2 , CIT and Sweet Talk ( n=33 ) ; or group 3 , IIT and Sweet Talk ( n=31 ) . Vascular assessments ( including measures of endothelial damage , activation , dysfunction and oxidative stress ) and HbA1c were performed at baseline and repeated after 12 months of the study . RESULTS Glycaemic control deteriorated in patients on CIT , but improved significantly in patients allocated to IIT ( p=0.007 ) . IIT was associated with significantly greater improvements in E-selectin ( p < 0.0001 ) than CIT ( group 1 , p=0.026 and group 2 , p=0.053 ) . Vascular responses to acetylcholine improved in patients on IIT ( p=0.017 ) , but not in patients receiving CIT . These changes were all independent of HbA1c level . CONCLUSIONS/INTERPRETATION IIT appears to be associated with improvements in vascular markers , independently of changes in HbA1c , suggesting that IIT may confer vascular protection in addition to improving glycaemic control .
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Intervention_Physical
Intensive insulin therapy
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Intervention_Physical
intensive diabetes management [ intensive
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Intervention_Educational
'Sweet Talk ' text-messaging support ]
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Intervention_Pharmacological
conventional insulin therapy ( CIT )
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Intervention_Physical
CIT
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Intervention_Educational
only ( n=28 ) ; group 2 ,
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Intervention_Physical
CIT and Sweet
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Intervention_Educational
Talk ( n=33 ) ; or group 3 , IIT and Sweet Talk ( n=31 )
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Outcome_Physical
endothelial function
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Outcome_Physical
endothelial function
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Outcome_Physical
Vascular assessments ( including measures of endothelial damage , activation , dysfunction and oxidative stress )
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Outcome_Physical
HbA1c
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Outcome_Physical
Glycaemic control
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Outcome_Physical
E-selectin
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Outcome_Physical
Vascular responses
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Outcome_Physical
vascular markers
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Outcome_Physical
glycaemic control
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Participant_Age
young people
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Participant_Condition
type 1 diabetes
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Participant_Sample-size
One hundred and twenty-six patients
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Participant_Age
aged between 8 and 18 years