Introduction We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes.
Research design and methods 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size.
Results 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI −0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI −0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI −0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9–10.0 mmol/L) and crPWV (r=−0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found.
Conclusion There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk.
Trial registration number NCT02637154.
- pediatric type 1 diabetes
- adolescent diabetes
- arterial stiffness
- intima-media thickness
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M-AP and A-KT are joint first authors.
Contributors M-AP, A-KT, MH and TS designed the study and were responsible for study subject enrollment and data collection. DG was responsible for the 15AG analyses. TS analyzed the data and wrote the manuscript with input from M-AP, A-KT, MH and DG. M-AP and TS take responsibility for the contents of the article.
Funding This study was supported by grants from the Foundation for Pediatric Research and the Diabetes Research Foundation. MH was supported by grants from the Academy of Finland and Finnish Foundation for Pediatric Research. DG was supported by grants from the Academy of Finland, the Medical Society of Finland, University of Helsinki and Sigrid Juselius Foundation. TS was supported by grants from Finnish Foundation for Pediatric Research, Medicinska Understödsföreningen Liv och Hälsa rf, Sigrid Juselius Foundation, Perklen foundation, Stockmann Foundation and the Medical Society of Finland.
Disclaimer No parts of the study has been previously presented in abstract form.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Helsinki University Hospital Ethics Committee for gynaecology and obstetrics, pediatrics and psychiatry approved the research protocol (138/13/03/03/2011/166 and 373/13/03/03/2014/279), and written informed consent was obtained from the participants at enrollment.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available from the corresponding author on reasonable request.
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