Evaluation of Vascular Resistance in the Intracerebral and Extracerebral Arteries in Patients with Diabetes Mellitus type 1 - preliminary results Author:

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Evaluation of Vascular Resistance in the Intracerebral and Extracerebral Arteries in Patients with Diabetes Mellitus type 1 - preliminary results Author: Justin Nealis Tutors: dr n. med. Mikolaj Pawlak Aleksandra Uruska lek. med. Jedrzej Ziółkiewicz Prof. Dorota Zozulińska-Ziółkiewicz Prof. Radosław Kaźmierski Department of Internal Medicine and Diabetology Department of Neurology and Cerebrovascular Disorders

Diabetes Mellitus type 1 & Cerebrovascular disease Patients suffering from Diabetes Mellitus type 1 have a threefold increase in risk for cerebrovascular disease compared to the non-diabetic control population. Atherosclerosis can stiffen and clog the cerebral arteries Ischemic stroke Microangiopathic defects within the small arteries of the brain can lead to lacunar infarctions. Can progress to vascular dementia Decline in cognitive function. White matter diseases

Aims of the study To evaluate the association of cerebrovascular resistance measures from transcranial color coded sonography with biochemical markers of cerebral vessel damages in the course of diabetes mellitus type 1. When should we start screening Diabetic patients for cerebrovascular disease? HbA1c? Disease duration?

Methods Transcranial color coded Doppler ultrasonography Temporal Window Subobccipital Window 2-4 mhz transducer Measured Pulsatility (PI) and Resistance (RI) indexes: Anterior Cerebral Artery (ACA) Middle Cerebral Artery (MCA) Posterior Cerebral Artery (PCA) Internal Carotid Artery (ICA) siphon Basillar artery Common Carotid Artery (CCA) External Carotid Artery (ECA) Internal Carotid Artery (ICA)

Waveform and spectrum analysis HbA1c concentration valid for 3 months Department of Internal Medicine and Diabetology Demographic data(age, gender, education, profession) Exposure to environment stroke risk factors was collected Recent Lab Data

Clinical Characteristics of Subjects Number of subjects 37 (43% female) Age 37 +/- 8(iqr) Age of DM1 diagnosis 24 +/-7 (iqr) Disease duration 13 +/- 1.68 years BMI 25 +/- 4 HbA1c concentration 8.45 +/- 1.44 %. Smoking history 11 (29.7%) Systolic BP 132 +/- 18 Diastolic BP 83 +/- 11

Clinical Characteristics of Subjects LDL 114.5 +/- 33.5 HDL 61.94 +/- 13.878 Triglycerides 105 +/- 63 Total Cholesterol 194 +/- 38 Fasting Glycemia 156 +/- 48 Glucose 2 hours post partum 156 +/- 30 Chronic Complications: Diabetic Nephropathy 13 (35%) Diabetic Neuropathy 3 (8%) Arterial Hypertension 9 (24%)

Patient’s BMI- Left ICA-RI (P=0.015)

HbA1c- L-ACA-RI (P= 0.017) HbA1c- R-MCA-RI (P= 0.037)

Preliminary Results Comparing HbA1c concentrations to the cerebral arteries: Left ACA- RI (p= 0.017) Right MCA-RI (p= 0.037) Patient’s BMIs: Right MCA- RI (P= 0.035) Right PCA-RI, (P= 0.015) Left ICA-RI (P=0.015) LDL- L-ACA- RI (P=0.047) Young patient population Short disease duration Need healthy control group

Thanks Department of Internal Medicine and Diabetology Department of Neurology and Cerebrovascular Disorders