# Sudomotor dysfunction reflects early atherosclerosis risk in adults with type 1 diabetes

## TL;DR

This study shows that early nerve dysfunction in type 1 diabetes is linked to increased risk of atherosclerosis and vascular aging.

## Contribution

The study introduces sudomotor function testing as a potential non-invasive tool for assessing cardiovascular risk in type 1 diabetes.

## Key findings

- Participants with sudomotor dysfunction had significantly thicker carotid intima-media and higher vascular age.
- Reduced sudomotor function remained significantly associated with vascular age after adjusting for key factors.
- Sudomotor dysfunction is linked to early signs of atherosclerosis in adults with type 1 diabetes.

## Abstract

Adults with type 1 diabetes (T1D) are at increased risk of premature atherosclerosis. Sudomotor dysfunction (SMD), an early manifestation of diabetic neuropathy, may contribute to vascular injury. This cross-sectional study assessed the relationship between sudomotor function (SMF), carotid intima-media thickness (cIMT), and vascular age (VA) in T1D. The study included 299 adults with T1D (137 men), aged 34 (IQR: 25–44) years, disease duration 16 (IQR: 11–25) years, and HbA1c of 7.7 (IQR: 7.0–8.7)%. Sudomotor function was measured with the SUDOSCAN device; abnormal function was defined as Feet ESC < 70 µS (SMD). cIMT was assessed with carotid ultrasound, and VA was derived from cIMT values. Participants with SMD had thicker cIMT [0.56 (IQR: 0.5–0.67) vs 0.54 (0.48–0.52), p = 0.04] and higher VA [48 (36–70) vs 42 (32–58), p = 0.04]. We found a negative correlation between Feet ESC and cIMT (Rs = − 0.22, p < 0.001). In a multiple linear regression model adjusted for sex, HbA1c, BMI, and creatinine, reduced Feet ESC remained significantly associated with VA (β = 0.13, p = 0.03), R2 = 0.065. SMD is associated with increased cIMT and VA in adults with T1D. SMF assessment by SUDOSCAN may represent a rapid, non-invasive tool to identify individuals at higher cardiovascular risk.