Acute hyperglycaemia rapidly increases arterial stiffness in young patients with type 1 diabetes (original) (raw)
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The Journal of Clinical Endocrinology & Metabolism, 2016
Context: Patients with type 2 diabetes (T2D) are at an increased risk of cardiovascular disease. Objective: The objective of the study was to determine whether postprandial hyperglycemia affects arterial function in T2D. Design: A single-center, open-label study of three groups of men were studied: 1) T2D patients with albuminuria (n ϭ 22), 2) T2D patients without albuminuria (n ϭ 24), and 3) nondiabetic controls (n ϭ 25). Patients were randomized to a two-period crossover study schedule, ingesting breakfast, with or without insulin lispro (to induce low or high postprandial glycemia). Main Outcome Measures: Arterial stiffness was assessed by calculating pulse wave velocity (PWV) and augmentation index using applanation tonometry, and endothelial dysfunction was assessed using peripheral arterial tonometry, 30 minutes before breakfast and up to 240 minutes after breakfast. Results: At baseline, arterial stiffness was increased in patients. When adjusted for age and body mass index, in a combined group of patients with and without albuminuria, brachial PWV was higher during low (P ϭ .032) and high (P ϭ .038) postprandial glycemia vs controls. These differences were driven by the albuminuria group vs controls during low (P ϭ .014) and high (P ϭ .018) postprandial glycemia. No differences were observed in aortic PWV, augmentation index, or peripheral arterial tonometry ratio between patients and controls. Endothelin-1 and IL-6 were higher, and superoxide dismutase was lower, during postprandial hyperglycemia in T2D patients vs controls. Conclusions: In patients with T2D and albuminuria, brachial PWV was higher under postprandial hyperglycemic conditions, relative to controls. These data suggest that hyperglycemia induces an increase in stiffness of intermediate-sized arteries. We found no changes in other parts of the arterial bed.
Journal of diabetes science and technology, 2015
The prevalence of cardiovascular risk factors among patients with type 1 diabetes is underestimated. This study was conducted to assess the cardiovascular risk by comparing arterial stiffness in type 1 diabetes with that of controls. Thirty-one type 1 diabetes patients and 31 age- and gender-matched controls were included. The brachial-ankle pulse wave velocity (ba-PWV) was measured using Periscope, a noninvasive device. The ba-PWV was found to be significantly elevated among the patients with diabetes (1177.09 ± 180.1 cm/s) when compared with the controls (1057.99 ± 95.8 cm/s) (P = .003). The ba-PWV showed positive correlation with age (r = .43, P = .014), heart rate (r = .49, P = .005), blood pressure (r = .65, P < .001), and LDL (r = .46, P = .008) among patients with diabetes. Linear regression analysis revealed that diabetes, age, systolic blood pressure (SBP), and BMI were independently associated with ba-PWV (R (2) = .589). On subdividing the diabetes cohort into quintiles...
Vessel wall stiffness in type 1 diabetes and the central hemodynamic effects of acute hypoglycemia
AJP: Endocrinology and Metabolism, 2007
Sommerfield AJ, Wilkinson IB, Webb DJ, Frier BM. Vessel wall stiffness in type 1 diabetes and the central hemodynamic effects of acute hypoglycemia. Am J Physiol Endocrinol Metab Objective: To examine the effects of intravenous insulin and acute hypoglycemia on arterial wall stiffness and central hemodynamic responses in adults with and without type 1 diabetes. Research Design and Methods: In 30 young male volunteers [10 nondiabetic (Group 1); 10 with type 1 diabetes, Ͻ5 yr duration (Group 2); 10 with type 1 diabetes, Ͼ15 yr duration (Group 3)], intravenous insulin was administered to provoke an acute autonomic reaction (R) to hypoglycemia. Heart rate, peripheral blood pressure, and pulse wave analysis (radial artery) were monitored. Augmentation index (AIx), a measure of arterial wall stiffness and wave reflection, and central arterial pressure were recorded. Results: At baseline, no significant differences were observed between Groups 1 and 2 in either AIx or in central arterial pressure, but in Group 3, both measures were significantly higher. All three groups exhibited similar responses to intravenous infusion of insulin and to hypoglycemia: AIx fell progressively from baseline to R, peripheral systolic blood pressure increased, and central systolic pressure decreased. Conclusion: Compared with age-and sex-matched nondiabetic controls, people who had type 1 diabetes for a long duration had increased stiffness of vessel walls. The opposing responses in peripheral and central systolic pressures during hypoglycemia may be related to the reduction in AIx, which causes diminished amplification of the systolic pressure wave. Changes in AIx are probably mediated by a direct action of insulin on arterial endothelium, or changes in heart rate. These functional changes may contribute to the increased cardiovascular morbidity that is associated with type 1 diabetes of long duration. arterial wall stiffness; central arterial pressure; insulin Address for reprint requests and other correspondence: B. M. Frier,
Glucose variability, blood pressure and arterial stiffness in type 1 diabetes
Diabetes Research and Clinical Practice, 2008
Aims: Evidence suggests that chronic hyperglycaemia predicts not only microvascular disease but also macrovascular disease, however it is not known whether it is the glucose variability per se or the total glucose exposure that confers risk. The objective of this study was to investigate whether daily glucose variability influence blood pressure and arterial stiffness, an early sign of macrovascular disease, at baseline and during a hyperglycaemic clamp in patients with type 1 diabetes. Methods: Twenty-two non-smoking male patients with type 1 diabetes without any diabetic complications, participated in the study. The patients were monitored for 72-h using a continuous glucose monitoring system. Before and during a 2-h hyperglycaemic clamp, blood pressure as well as pulse wave analysis and pulse wave velocity (PWV) were performed to assess arterial stiffness. Results: No correlation was observed between mean amplitude of glycaemic excursions (MAGE) and arterial stiffness at baseline. There was a correlation between mean daily glucose and aortic PWV even after adjusting for BMI, HbA 1c , and duration of diabetes in a multiple regression analysis (r = 0.48; P < 0.01). MAGE (r = 0.52; P < 0.01) correlated independently with the change in aortic DBP during the clamp. Conclusions: This study suggests that high mean daily blood glucose but not glucose variability per se is associated with arterial stiffness in patients with T1D. Daily glucose variability is positively associated with the change in central blood pressure during a hyperglycaemic clamp.
Relationship between glycaemic levels and arterial stiffness in non-diabetic adults
Medicina Clínica (English Edition), 2018
Objective: To examine, in a non-diabetic population, whether the association between arterial stiffness and glycaemic levels depends on the test used as a glycaemic indicator, fasting plasma glucose (FPG) or glycated haemoglobin A1c (HbA1c). Patient population and methods: A cross-sectional analysis of a 220 non-diabetic subsample from the EVIDENT II study in which FPG, HbA1c and arterial stiffness-related parameters (pulse wave velocity, radial and central augmentation index, and central pulse pressure) were determined. Mean differences in arterial stiffness-related parameters by HbA1c and FPG tertiles were tested using analysis of covariance. Results: All means of arterial stiffness-related parameters increased by HbA1c tertiles, although mean differences were only statistically significant in pulse wave velocity (p ≤ 0.001), even after controlling for potential confounders (HbA1c <5.30% = 6.88 m/s; HbA1c 5.30-5.59% = 7.06 m/s; and HbA1c ≥5.60% = 8.16 m/s, p = 0.004). Conversely, mean differences in pulse wave velocity by FPG tertiles did not reach statistically significant differences after controlling for potential confounders (FPG 4.44 mmol/l = 7.18 m/s; FPG 4.44-4.87 mmol/l = 7.26 m/s; and FPG ≥4.88 mmol/l = 7.93 m/s, p = 0.066). Conclusions: Glucose levels in a non-diabetic population were associated with arterial stiffness but better when levels were determined using HbA1c.
The Journal of Clinical Endocrinology & Metabolism, 2014
Context: Hyperglycemia is associated with a higher carotid intima-media thickness (IMT); however, it is not established whether this increase reflects early atherosclerotic changes or adaptive remodeling responding to hyperglycemia-induced alteration in mechanical properties of the arterial wall. Objective: The aims of this study were to compare carotid geometry and circumferential wall stress between patients with type 2 diabetes mellitus (T2DM) and healthy controls and to evaluate the associations between chronic glucose exposure and measures of arterial structure and function. Design and Setting: This was a case-control and cross-sectional study within institutional practice. Participants: Participants included 133 T2DM patients free of cardiovascular complications and 133 healthy controls with normal glucose metabolism, matched for sex, age, and body mass index. Main Outcome Measures: Common carotid artery (CCA) IMT, luminal diameter, wave speed, and local pulse pressure (PP) were evaluated. Results: As compared with controls, T2DM patients had higher (P Ͻ .0001) CCA IMT (640 Ϯ 81 vs 709 Ϯ 118 m), luminal diameter (6.12 Ϯ 0.67 vs 6.69 Ϯ 0.56 mm), and brachial PP (47 Ϯ 7 vs 57 Ϯ 12 mm Hg), whereas luminal radius to IMT ratio (4.8 Ϯ 0.7 vs 4.8 Ϯ 0.8, P ϭ .57) and circumferential wall stress (49.0 Ϯ 8.3 vs 50.6 Ϯ 10.3 kPa, P ϭ .26) were comparable between the 2 groups. In T2DM patients, glycosylated hemoglobin was independently related to CCA wave speed and local PP, but not to IMT that was determined by age, local PP, and luminal diameter. Conclusions: This study suggests that the increase in IMT associated with a higher glucose exposure might reflect adaptive remodeling counteracting an increase in pulsatile strain and preventing increase in circumferential wall stress caused by luminal enlargement of stiff arteries.
Diabetologia, 2012
Aims/hypothesis Endothelium-derived factors are thought to be physiological modulators of large artery stiffness. The aim of the study was to investigate whether endothelial function could be a determinant of arterial stiffness in essential hypertensive patients, in relation with the concomitant presence of type 2 diabetes mellitus. Methods The study included 341 participants (84 hypertensive patients with and 175 without type 2 diabetes mellitus, 82 matched controls). Brachial artery endotheliumdependent flow-mediated dilation (FMD) was determined by high-resolution ultrasound and computerised edge detection system. Applanation tonometry was used to measure carotid-femoral pulse wave velocity (PWV). Results Hypertensive patients with diabetes had higher PWV (10.1±2.3 m/s vs 8.6±1.4 m/s, p<0.001) and lower FMD (3.51±2.07 vs 5.16±2.96%, p<0.001) than non-diabetic hypertensive patients, who showed impaired vascular function when compared with healthy participants (7.9±1.6 m/s and 6.68 ± 3.67%). FMD was significantly and negatively correlated to PWV only in hypertensive diabetic patients (r0−0.456, p<0.001), but not in hypertensive normoglycaemic patients (r0−0.088, p00.248) or in healthy participants (r 00.008, p 00.946). Multivariate analysis demonstrated that, in the diabetic group, FMD remained an independent predictor of PWV after adjustment for confounders (r 2 00.083, p 00.003). Subgroup analysis performed in non-diabetic hypertensive patients revealed that neither obesity nor the metabolic syndrome affected the relationship between FMD and PWV. Conclusions/interpretation Endothelial dysfunction is a determinant of aortic stiffness in hypertensive diabetic patients but not in hypertensive patients without diabetes. These results suggest that type 2 diabetes mellitus on top of hypertension might worsen arterial compliance by endothelium-related mechanisms.
Diabetes/Metabolism Research and Reviews, 2010
Aim Glucose intolerance produces structural and functional changes in the arterial wall. The present study investigated association between glucose tolerance status and arterial stiffness in subjects with normal and impaired glucose regulation (IGR). Methods The study group consisted of 284 subjects, including 111 subjects with normal fasting glucose (NFG), 61 subjects classed as impaired fasting glucose (IFG) according of the new fasting blood glucose (FBG) cutoff point of 100 mg/dL and 112 patients with diabetes mellitus (DM). All patients were evaluated for glucose, HbA1C, insulin, lipids, C-reactive protein (CRP) and homeostasis model assessment-insulin resistance. Pulse wave velocity (PWV) and augmentation index (AI) were performed as a noninvasive recording of the two artery sites pressure waveform using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia). Results Pulse wave velocity, augmentation index and central arterial pressure increased consistently with deterioration of glucose tolerance. PWV was significantly higher in subjects with diabetes than in the normal and IFG groups (p < 0.0001 and p = 0.007, respectively). IFG subjects had marginally higher PWV than normal subjects (p = 0.050). Compared to normal subjects, IFG and diabetes groups were associated with increased AI (p = 0.003 and p < 0.0001, respectively). Arterial stiffness parameters remained significantly higher in both IFG and diabetes groups compared to normal after adjustment for cardiovascular risk factors and concomitant medications. Positive correlations between FBG, HbA1C and arterial stiffness parameters were detected. Conclusions Arterial stiffness parameters varied significantly across subgroups of patients with different degrees of impaired glucose regulation, such that increasingly deranged glucose homeostasis was associated with increased arterial stiffness. Early adverse vascular changes were detected in subjects with IFG.
International Heart Journal, 2013
Premature arteriosclerosis may be one of the mechanisms linking pre-diabetes mellitus (pre-DM) and cardiovascular disease. We sought to characterize premature arteriosclerosis in pre-DM using different arterial stiffness indices and to fi nd the independent contributors of this process. We recruited 33 patients without DM, 53 patients with pre-DM, and 34 subjects with DM. Both the compliance index (CI) and stiffness index (SI) were measured. Patients with pre-DM and DM had lower CI (3.8 ± 2.1 versus 5.2 ± 3.0 units; P < 0.05 and 3.6 ± 1.8 versus 5.2 ± 3.0 units; P < 0.05, respectively) and higher SI (8.0 ± 2.0 versus 6.7 ± 1.6 m/s; P < 0.01 and 9.4 ± 2.3 versus 6.7 ± 1.6 m/s; P < 0.001, respectively) than patients without DM. Using multivariate linear regression analysis, age, heart rate, and HOMA index were independent determinants for SI (whole model: R 2 = 0.47, P < 0.001), whereas male gender, hsCRP, and HOMA index were independent determinants for CI (whole model: R 2 = 0.34, P < 0.01). The HOMA index was an independent determinant for arterial stiffness. Increased insulin resistance may associate with increased arterial stiffness at peripheral arteries in pre-DM patients.