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Detecting Damage Detecting Damage

August 2004

by Will Sansom

Seven-year-old Fritzy Davis sat with a cuff on her arm for five minutes to help researchers test a hypothesis - that the damage caused by diabetes can be detected in blood vessels of children as young as 5.

The researchers, who include Daniel Hale, M.D., professor of pediatrics, Eugenio Cersosimo, M.D., associate professor of medicine, and Estela Wajcberg, M.D., research fellow, are using high-resolution ultrasound to capture images of the brachial artery, which supplies blood to the arm and fingers. The cuff is connected to a computer that displays the data. The brachial artery is comparable in size to the coronary arteries, so it is expected to be a good predictor of coronary artery disease.

"There is fairly good evidence that when someone develops diabetes, they are already at high risk for stroke or cardiovascular disease," Dr. Cersosimo said. "The strategy is to go after them much earlier, to control their diabetes much earlier."

The study is of children ages 5 to 17 in four groups - those who have type 2 diabetes, those who have type 1 diabetes, those who do not have diabetes but whose body mass index indicates they are at risk for obesity, and healthy controls like Fritzy. Fifty children are being enrolled in each group.

The researchers measure the diameter of the brachial artery and the velocity of blood flow through it. The test closes the artery. After releasing, the blood flow should be two or three times normal to compensate.

"Adults who have vascular abnormalities due to diabetes do not show a normal response to this test," Dr. Cersosimo said. "Their post-test response is not quite as robust. The question is: Do children also have this abnormality?"

Two drugs, pioglitazone and rosiglitazone, are known to improve the vascular response. Prescribing one of these medications, along with exercise and dietary changes, might delay a child’s progress to type 2 diabetes, Dr. Cersosimo said.
Parents may call (210) 358-7200 to ask about the study.


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