Subclinical arterial damage in children and adolescents with type 1 diabetes: A systematic review and meta‐analysis

Background and Objective Type 1 diabetes is an important risk factor for the development of cardiovascular disease. Pulse wave velocity (PWV) and carotid intima‐media thickness (cIMT) measurements are well recognized as independent predictors for future cardiovascular disease. The aim of the present study was to systematically review the literature and conduct a meta‐analysis assessing measures of subclinical arterial damage in children and adolescents with type 1 diabetes in comparison to healthy controls. Methods PubMed and Cochrane Library were searched to identify studies comparing cIMT and carotid‐femoral PWV levels between children with type 1 diabetes and healthy controls. Meta‐analysis was performed to compare the difference of overall mean cIMT and carotid‐femoral PWV levels between the two groups. New Castle Ottawa quality assessment scale for case‐control studies was used to assess study quality. Results Twenty‐three studies were finally included in the meta‐analysis (20 studies for cIMT and 4 studies for carotid‐femoral PWV). Youth with type 1 diabetes had significantly higher cIMT levels than controls (mean difference [d] = 0.03, 95% confidence interval [CI] = 0.02‐0.04), as well as higher carotid‐femoral PWV levels (d = 0.26, 95% CI = 0.18‐0.34). Heterogeneity was present only in the cIMT analysis (I2 > 90%). Conclusions Youth with type 1 diabetes showed signs of subclinical arterial damage, as suggested by higher levels of cIMT and carotid‐femoral PWV compared to healthy controls at childhood and adolescence. Preventive and therapeutic interventions early in course of disease may be further studied to decrease morbidity in this high‐risk young patient group. PROSPERO registration number: 2018 CRD42018094354.