Early Microvascular Changes with Loss of the Glycocalyx in Children with Type 1 Diabetes

Objective To evaluate the microcirculation of children with type 1 diabetes mellitus who demonstrate no clinical signs of diabetic microangiopathy for the presence of microvascular alterations and glycocalyx perturbation. Study design Images of sublingual vessels were obtained in 14 children with diabetes (ages 12.8 +/- 2.8 years, diabetes duration 6.7 +/- 4.3 years) and 14 control patients (ages 11.8 +/- 2.8 years) by the use of sidestream dark field imaging and analyzed for total vessel density, vessel surface coverage, vessel diameter distribution, mean flow index, and glycocalyx thickness. Wilcoxon rank sum test and Pearson correlation were used for statistical analysis. Results We observed profound microcirculatory changes in children with diabetes compared with control patients, with a significant reduction of glycocalyx thickness (0.38 mu m vs 0.60 mu m; P = .013), which was inversely correlated with blood glucose levels (r = -0.55; P = .003). Furthermore, the percentage of large vessels (>20 mu m diameter) was significantly increased (11% vs 6%; P = .023) at the expense of capillaries (<10 mu m diameter) with consequent increase in total vessel surface coverage (30% vs 26.0%; P = .041). No differences were seen in total vessel density and mean flow index. Conclusions Microvascular alterations, including changes in microvessel distribution and loss of the glycocalyx, can be detected in children with type 1 diabetes mellitus before clinically apparent vascular complications. Our results disclose the glycocalyx as a possible monitoring measurement for earlier detection of diabetic microangiopathy and may provide a basis for new therapeutic strategies aiming at protection or restoration of the glycocalyx.