O-48: Global longitudinal strain as an early marker of cardiac dysfunction in children with type 1 diabetes: the impact of glycemic metrics, treatment modality, and diabetic ketoacidosis at diagnosis
Ö Kayır Kurt, H Kurt, H Işıklar, A Suner, D Özalp Kızılay, E Doğan, Z Ülger Tutar, S Özen, E Levent, D GökşenAbstract
Introduction
Cardiovascular disease is a leading cause of morbidity and mortality in type 1 diabetes (T1D). Global longitudinal strain (GLS), reflecting myocardial deformation, is a sensitive marker of early systolic dysfunction before conventional echocardiographic abnormalities become evident.
Objectives
To evaluate GLS in detecting early systolic dysfunction in pediatric T1D without clinical cardiovascular complications, and to investigate effects of insulin modality, glycemic metrics, and diabetic ketoacidosis (DKA) at diagnosis.
Methods
102 children with T1D and 51 matched controls underwent speckle-tracking echocardiography. GLS values closer to zero indicate impaired contractility. Systolic function was analyzed by metabolic control, DKA history, and insulin modality per ISPAD guidelines.
Results
Conventional parameters were preserved, but GLS was significantly worse in T1D (−17.85 vs−18.90; p<0.001). CSII users had better GLS than MDI (−17.99 vs−17.10; p=0.005). TIR>70% was associated with better contractility (−18.14 vs−17.29; p=0.008). Time above range, level 1 hypoglycemia, and higher GMI correlated with impaired function (p=0.045, p=0.008, p=0.002). DKA at diagnosis predicted worse GLS (−17.14 vs−18.15; p=0.001). In multivariable lineer regression, DKA (p=0.004) and MDI (p=0.015) were independent predictors. GLS discriminated T1D from controls (AUC=0.744; cut-off −18.45, 75.5% sensitivity, 66.7% specificity). DKA was the strongest predictor of myocardial dysfunction (OR:3.15, p=0.019).
Conclusions
GLS sensitively detects early myocardial impairment in pediatric T1D despite normal conventional echocardiography. CSII and higher TIR appear cardioprotective; DKA at diagnosis is a strong independent risk factor for long-term cardiac dysfunction.