Non-invasive, Complex Examination of Micro- and Macrovascular System of Patients with Type 1 Diabetes Mellitus with or Without Vascular Complications

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Abstract

Objective: We examined the vascular system, from the microvasculature to the aorta, in diabetes mellitus, using non-invasive methods.

Methods: We enrolled patients with type 1 diabetes: 17 patients without complications (DMW) and 19 patients with clinically manifest complications (DMC). Control group was represented by 34 healthy volunteers (C). We examined microvascular function with laser-Doppler flowmetry, using post-occlusive reactive hyperemia test and local heating. Arterial stiffness was studied by arteriograph, determining augmentation index and pulse wave velocity. We measured serum levels of sE-selectin and sICAM-1, markers of endothelial dysfunction.

Results: Microvascular reactivity was significantly reduced in DMC-, and tendentiously in DMW groups. sE-selectin level was significantly higher in DMC group than in controls. Arterial stiffness was the highest in the DMC group and the lowest in the DMW group. Heart rate was significantly higher in both diabetic groups compared to controls. Time to maximum flow during PORH test tended to be the shortest in DMW group.

Conclusions: Our results confirm impairment of the microvascular system in diabetic patients, even in early, uncomplicated stage of the disease, and might demonstrate diffuse hyperkinesis in the vascular system, resulting from the insulin effect or refering to the “vasodilation phase” of diabetes mellitus.

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  • 1. Fox CS Coady S Sorlie PD et al. Trends in Cardiovascular Complications of Diabetes. JAMA 2004;292:2495-2499.

  • 2. Schalkwijk CG Stehouwer CDA. Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin Sci. 2005;109:143-159.

  • 3. Rossing P. The changing epidemiology of diabetic microangiopathy in type 1 diabetes. Diabetologia. 2005;48: 1439-1444.

  • 4. Cameron JD Cruickshank JK. Glucose insulin diabetes and mechanisms of arterial dysfunction. Clin Exp Pharmacol P. 2007;34:677-682.

  • 5. Fichtlscherer S Breuer S Zeiher AM. Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the “vulnerable” patient. Circulation. 2004;110:1926-1932.

  • 6. Barac A Campia U Panza JA. Methods for Evaluating Endothelial Function in Humans. Hypertension. 2007;49: 748-760.

  • 7. Cracowski JL Minson CT Salvat-Melis M Halliwill JR. Methodological issues in the assessment of skin microvascular endothelial function in humans. TRENDS Pharmacol Sci. 2006;27(9):503-508.

  • 8. Hansell J Henareh L Agewall S Norman M. Non-invasive assessment of endothelial function — relation between vasodilatory responses in skin microcirculation and brachial artery. Clin Physiol Funct I. 2004;24:317-322.

  • 9. Willum-Hansen T Staessen JA Torp-Pedersen C et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113:664-670.

  • 10. Kubli S Waeber B Dalle-Ave A Feihl F. Reproducibility of Laser-Doppler Imaging of Skin Blood Flow as a tool to Assess Endothelial Function. J Cardiovasc Pharm. 2000;36(5):640-648.

  • 11. Gomes MB Matheus ASM Tibirica E. Evaluation of microvascular endothelial function in patients with type 1 diabetes using laser-Doppler perfusion monitoring: Which method to choose? Microvasc Res. 2008;76:132-133.

  • 12. Baulmann J Schillings U Rickert S Uen S Düsing R Illyes M Cziraki A Nickenig G Mengden T. A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods. J Hypertens. 2008; 26:523-528.

  • 13. Horváth IG Németh Á Lenkey Zs et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index central blood pressure and aortic pulse wave velocity. J Hypertens. 2010;28(10):2068-2075.

  • 14. Vinik AI Maser RE Mitchell BD Freeman R. Diabetic Autonomic Neuropathy. Diabetes Care. 2003;26:1553-1579.

  • 15. Romney JS and Lewanczuk RZ. Vascular Compliance Is Reduced in the Early Stages of Type 1 Diabetes. Diabetes Care. 2001;24:2102-2106.

  • 16. Gianattasio C Failla M Piperno A Grappiolo A Gamba P Paleari F Mancia G. Early impairment of large artery structure and function in Type I diabetes mellitus. Diabetologia. 1999; 42:987-994.

  • 17. Kahn F Elhadd TA Greene SA Belch JJF. Impaired Skin Microvascular Function in Children Adolescents and Young Adults With Type 1 Diabetes. Diabetes Care. 2000;23:215-220.

  • 18. Tibiriçá E Rodrigues E Cobas RA Gomes MB. Endothelial function in patients with type 1 diabetes evaluated by skin capillary recruitment. Microvasc Res. 2007;73:107-112.

  • 19. Skrha J Prazny M Haas T Kvasnicka J Kalvodova B. Comparison of laser-Doppler flowmetry with biochemical indicators of endothelial dysfunction related to early microangiopathy in Type 1 diabetic patients. J Diabetes Complicat. 2001;15:234-240.

  • 20. Tur E Yosipovitch G Bar-On Y. Skin reactive hyperemia in diabetic patients. A study by laser-Doppler flowmetry. Diabetes Care. 1991;14(11):958-962.

  • 21. Yngen M Östenson CG Hu H Li N Hjemdahl P Wallen NH. Enhanced P-selectin expression and increased soluble CD40 Ligand in patients with Type 1 diabetes mellitus and microangiopathy: evidence for platelet hyperactivity and chronic inflammation. Diabetologia. 2004;47:537-540.

  • 22. Woodman RJ Watts GF. Measurement and application of arterial stiffness in clinical research: focus on new methodologies and diabetes mellitus. Med Sci Monit. 2003;9(5):RA101-109.

  • 23. Vervoort G Wetzels JF Lutterman JA van Doorn LG Berden JH Smits P. Elevated skeletal muscle blood flow in noncomplicated type 1 diabetes mellitus. Hypertension. 1999; 34:1080-1085.

  • 24. Wilkinson IB MacCallum H Rooijmans DF et al. Increased augmentation index and systolic stress in type 1 diabetes mellitus. Q J Med. 2000;93:441-448.

  • 25. Westerbacka J Wilkinson I Cockcroft J Utriainen T Vehkavaara S Yki-Jarvinen H. Diminished Wave Reflection in the Aorta. A Novel Physiological Action of Insulin on Large Blood Vessels. Hypertension. 1999;33:1118-1122.

  • 26. The Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications Research Group. Intensive Diabetes Therapy and Carotid Intima-Media Thickness in Type 1 Diabetes mellitus. New Engl J Med. 2003;348:2294-2303.

  • 27. Meyer MF Schatz H. Influence of metabolic control and duration of disease on microvascular dysfunction in diabetes assessed by laser Doppler anemometry. Exp Clin Endocr Diab. 1998;106:395-403.

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