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

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.