This retrospective study was conducted by including two groups of pediatric patients. The first group (Group 1) consisted of 51 children diagnosed with type 1 diabetes mellitus who were under follow-up at the Pediatric Endocrinology Department of Hatay Mustafa Kemal University. The second group (Group 2) included 69 children aged 1-18 years without diabetes who were referred to the Pediatric Cardiology Department due to detected heart murmurs during sports license evaluations, without any identified cardiac pathology. Inclusion criteria for the diabetic group involved patients with type 1 diabetes without additional comorbidities who either had heart murmurs during an examination or were referred to pediatric cardiology due to symptoms such as palpitations or chest pain.

The work was evaluated and approved by the Ethnic Committee of the University of Hatay Mustafa Kemal. All procedures performed in studies involving human participants were by the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Participants were divided into two groups based on their medical conditions. Group 1 included children with type 1 diabetes, while Group 2 served as the control group of healthy children without diabetes. Patients in both groups were matched for age, sex, and anthropometric measurements. All participants had normal blood pressure and lipid levels. The insulin doses taken by children with type 1 diabetes were similar according to weight, and none of them had an insulin pump and were using more than one insulin.

Height, weight, and waist circumference measurements were taken at the Pediatric Endocrinology Clinic. Body mass index (BMI) was calculated for each participant. Additionally, echocardiographic measurements were performed for all patients at the Pediatric Cardiology Clinic. During echocardiographic assessments, the HbA1c levels at the time of measurement and the duration of diabetes diagnosis were noted.

A single pediatric endocrinologist made echocardiographic measurements. Each participant received a transthoracic two-dimensional guided M-mode echocardiogram. The ECHO procedure was performed with the Philips iE33 xMATRIX ultrasound device according to the pediatric ECHO guide of the American Society of Echocardiography. Epicardial fat tissue thickness was measured perpendicular to the myocardial wall in the parasternal long axis in the lateral decubitus position.7 During end-diastole, measurements were taken, as these values exhibit greater consistency with cardiac magnetic resonance imaging.8,9 A total of 3 measurements were taken and the average was taken.

Counts and percentages were used to summarize demographic and baseline clinical factors for each group with categorical variables, while mean ± SD was employed for continuous variables. Pearson correlations were utilized to explore the relationships between EAT, clinical characteristics, and cardiovascular measurements. ROC analysis was performed to evaluate the correct classification of epicardial fat tissue to determine the best cut-off point and to evaluate sensitivity and specificity values at different cut-off points. The optimal cut-off point was determined to achieve maximum sensitivity and specificity.

Demographic and baseline clinical factors were summarized for each group using counts and percent for categorical variables and mean ± SD for continuous variables. Associations between EAT, clinical characteristics, and cardiovascular measurements were examined using Pearson correlations. Differences in EAT between groups were compared by independent sample t tests and a general linear model adjusting for age, sex, and BMI. Multivariate linear regression analysis adjusting for age, sex, BMI, and diabetes status was used to examine EAT as a predictor for measurements of cardiovascular function that showed significant bivariate correlation. Data were analyzed using PASW Statistics 18 (PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.) with significance set at p < 0.05. Cohen’s d was used as a measure of effect size for group comparisons.

This study aimed to compare the cardiac health and anthropometric measurements of children with type 1 diabetes to those of healthy children and to evaluate the relationship between these factors and diabetes-related parameters.