Albuminuria and Carotid Atherosclerosis in Type 1 Diabetes Evaluated Using Three-Dimensional Vascular Ultrasound

INTRODUCTION: Presence of albuminuria is associated with high risk of cardiovascular disease (CVD) and premature mortality in individuals with type 1 diabetes. We aimed to investigate carotid atherosclerosis in individuals with type 1 diabetes compared with healthy controls and assess the association between presence of albuminuria and carotid atherosclerosis in type 1 diabetes using three-dimensional vascular ultrasound (3DVUS) and two-dimensional vascular ultrasound (2DVUS).

MATERIALS & METHODS: Cross-sectional study including 350 individuals, 290 with type 1 diabetes and 60 healthy controls. Carotid total plaque volume (TPV) was measured using 3DVUS and carotid maximal plaque thickness (cPTmax) using 2DVUS. TPV and cPTmax were highly skewed and analysed in four categories using unadjusted and adjusted ordinal logistic regression models. Albuminuria categories were defined by the highest persistent urinary albumin-creatinine ratio level recorded in each participant's medical history.

RESULTS: In the total cohort, 56% were men and mean (SD) age was 56 (14) years. Among the individuals with type 1 diabetes, 110 (38%) had normal-, 124 (43%) moderately increased- and 56 (19%) severely increased albuminuria. Individuals with type 1 diabetes had higher median [IQR] TPV of 28 [0-144] mm3 and cPTmax (14 [0-21] mm) compared to healthy controls (9 [0-54] mm3, 11 [0-17] mm). In adjusted ordinal logistic regression models, individuals with type 1 diabetes were more likely to be in a higher TPV category than healthy controls (0.82, 95% CI [0.16, 1.48], p = 0.015), whereas no difference was demonstrated for cPTmax. Among individuals with type 1 diabetes, presence of severely increased albuminuria was associated with being in a higher TPV category than normal albuminuria (1.40, 95% CI [0.61, 2.21], p < 0.001) after adjustment, whereas no difference was seen for cPTmax categories. Higher current albuminuria was associated with being in a higher TPV (p = 0.002) and cPTmax (p = 0.047) category after adjustment.

CONCLUSION: Participants with type 1 diabetes had higher carotid TPV than healthy controls independent of other risk factors and higher levels of albuminuria were associated with higher carotid TPV and cPTmax in type 1 diabetes.