Good glycemic control protects cardiovascular health in children with type 1 diabetes
Good glycemic control in children with type 1 diabetes is associated with a reduced risk of cardiovascular complications later in life. Early cardiovascular alterations may be slowed and, in some cases, partially reversed. These findings are presented in a doctoral thesis from the University of Gothenburg.
The thesis was authored by Ebba Bergdahl, who recently obtained her PhD at the Sahlgrenska Academy and is a physician in specialist training in emergency medicine at Sahlgrenska University Hospital, Östra. Her research investigated the impact of type 1 diabetes on the cardiovascular system in children and examined how these effects evolve over time.
“We see that effects on the heart and blood vessels can occur early in the course of the disease, relatively soon after diagnosis, even in children who are otherwise perceived as healthy,” says Ebba Bergdahl.
Advanced measurement methods and longitudinal follow-up
The studies were based on clinical examinations of children aged 6–16 years, with follow-up period of two years. Children with type 1 diabetes were compared with age-matched healthy control participants.
“Type 1 diabetes affects the body as a whole. By following the children over time, we can see both how the body is affected and how it responds to changes in treatment,” says Ebba Bergdahl.
High-resolution ultrasound imaging, capable of visualizing structures down to 30 micrometers, was used to examine vascular morphology in detail, including arteries in the wrist, foot, and neck. This technique enables differentiation between layers of the vessel wall and allows detection of subtle structural changes that were previously not observable.
In addition, the researchers assessed cardiac autonomic regulation and performed 24-hour ambulatory blood pressure monitoring to evaluate circadian blood pressure patterns.
Encouraging findings
The results show that children with type 1 diabetes may exhibit early changes in vascular structure and in cardiac autonomic regulation. Importantly, the thesis also reports findings that are more favorable than those described in earlier studies.
In children with well-managed diabetes, for example through modern hybrid closed-loop systems that integrate insulin pumps and continuous glucose sensors—improvements were observed at follow-up in both blood pressure regulation and cardiac autonomic function These improvements were associated with greater glycemic stability and increased time spent within the recommended glycemic range.
In contrast, previous studies have frequently reported a progressive deterioration of cardiovascular function in individuals with type 1 diabetes.
“We are in the midst of a technological leap in diabetes care, where automated insulin delivery systems provide new possibilities for achieving stable glycemic control, which likely explains the encouraging results observed in this study. With effective glycemic management, certain markers of cardiovascular involvement may even improve over time” says Ebba Bergdahl.
Sweden at the forefront
Pediatric diabetes care in Gothenburg and throughout Sweden is highly developed. Children with type 1 diabetes have access to advanced treatment modalities, including insulin pumps, continuous glucose monitoring systems, and modern insulin therapies. These resources provide favorable conditions for structured follow-up and sustained glycemic control.
Frida Dangardt, Associate Professor of Clinical Physiology at the Sahlgrenska Academy, University of Gothenburg, and Senior Consultant at Sahlgrenska University Hospital, was the principal supervisor of the doctoral project.
“These findings are of clear clinical relevance and underscore the importance of systematic efforts to achieve optimal glycemic control from an early stage of the disease. Publication of these studies in journals with broad international readership may contribute to increased prioritization of pediatric diabetes care in other healthcare systems,” says Frida Dangardt.
The thesis was defended on Friday, December 12, 2025.
The thesis is available at ub.gu.se: Advanced phenotyoing of cardiovascular risk in children with chronic disease- Children with type 1 diabetes and kidney transplant recipients
