"Type 1 diabetes means getting a heart scan in young adulthood"

As a person with type 1 diabetes, Cassie knows she must be careful to manage her disease and avoid serious complications. Getting a noninvasive HeartLung™ scan and CAC score after 20 years of her diagnosis at age 3 is the best way to detect if she has cardiovascular disease.

Cassie is an active 24-year-old who has had type 1 diabetes since she was 3. Because her pancreas isn’t able to produce insulin, for the past 21 years, she has required insulin injections several times a day.1 She must constantly monitor her blood sugar levels, carefully measure her food, and consistently make sure to exercise, in order to avoid getting sick.

Fortunately, Cassie has had excellent care since her diagnosis. Her parents worked closely with her endocrinologist to learn how to give the injections, prepare meals, and watch for changes in Cassie’s blood sugars. When she was 7-years-old, Cassie was able to get an insulin pump that could continuously monitor her blood sugar and administer insulin.

Having diabetes did not slow Cassie down. She was an excellent student, studied ballet, and was voted Class President in high school. During college, she adjusted to living away from home and was able to manage her diabetes without serious consequences. After graduation, she got a job as a data analyst for a software company.

During her annual check-up with her endocrinologist, he told Cassie that he would like to send her for a coronary artery calcium (CAC) scan. “You and your parents have always done well managing your diabetes,” he told her. “But after about 20 years, I want to find out if you have coronary artery disease (CAD). It’s different for everyone with childhood-onset type 1 diabetes, but up to 29% of these young patients may have some calcium and plaque build-up in the blood vessels that deliver blood and nutrients to the heart.” He explained that the most common complication of type 1 diabetes is CAD and its cousin, cardiovascular disease. If it was detected early, they could treat it aggressively. Cassie agreed to get the scan. Cassie learned that the CAC score (also called an Agatston score) would be done by a computed tomogram (CT) of the chest, which visualizes the heart. The CT takes multiple 3-mm slices through the coronary arteries between heart beats while she held her breath for about 20 seconds. The CAC score shows the total score of calcium that has accumulated in the main arteries of the heart. A score of 0 means there is no calcification: the higher the score, the greater the risk of a cardiovascular event—such as a heart attack—in the next ten years.

The scan was performed by HeartLung™, a company that uses Artificial Intelligence to analyze results and compare them to thousands of others for an accurate score. The HeartLungTM scan also assesses the lungs, liver, bones, and other body structures. Results are available within a few hours and are sent to both the patient and their health care provider.

Cassie’s epidemiologist had good news when she went in to review the results: her CAC score was 0! He explained that because so many complications of type 1 diabetes, such as heart attacks, kidney failure, blindness, and amputations, are caused by cardiovascular disease, he would recommend a repeat CAC scan in 4 or 5 years. By tracking Cassie’s CAC score, they could begin a new treatment if the score was more than 0.5

With the addition of a CAC score to Cassie’s treatment plan, she will be able to avoid the serious complications that can occur when type 1 diabetes isn’t carefully followed and managed.

REFERENCES

1. What is Type 1 Diabetes? Centers for Disease Control and Prevention, Atlanta, GA. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html

2. Medtronics Diabetes Devices. https://www.medtronicdiabetes.com/treatments/insulin-pump-therapy-for-kids

3. Schnell O et al. Type 1 diabetes and cardiovascular disease. Cardiovasc Diabetol12, 156 (2013). https://doi.org/10.1186/1475-2840-12-156

4. Burge M, Eaton P, Schade D. The Role of a Coronary Artery Calcium Scan in Type 1 Diabetes.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035375/#

5. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625