Vascular dysfunction and autonomic neuropathy in Type 2 diabetes

Diabetic Medicine - Tập 21 Số 7 - Trang 746-751 - 2004
Caroline Meyer1, Frances Milat2, Barry P. McGrath2, James D. Cameron2, Dimitra Kotsopoulos2, Helena Teede2
1Monash University Department of Medicine, Dandenong Hospital, David Street, Dandenong,Victoria 3175, Australia.
2Monash University Department of Medicine, Dandenong Hospital, Melbourne, Victoria, Australia

Tóm tắt

AbstractAims  To test the hypothesis that arterial dysfunction in Type 2 diabetes is related to autonomic neuropathy.Methods  Arterial function and autonomic neuropathy were assessed over two consecutive days in 45 Type 2 diabetic and control subjects. Systemic arterial compliance (SAC), arterial stiffness (pulse‐wave velocity, PWV) and carotid intima thickness (IMT) were assessed; these markers reflect early vascular disease and predict clinical vascular events. Autonomic neuropathy was assessed using heart rate variability with continuous ECG recording during various breathing and postural manoeuvres and an overall autonomic score was generated. Fasting metabolic parameters including glucose, insulin, HbA1c and lipid profile were measured.Results  Autonomic neuropathy tests were all repeatable in diabetic subjects. Compared with controls, diabetic subjects had arterial dysfunction with increased PWV (P = 0.009), IMT (P < 0.001) and reduced SAC (P = 0.053). After adjustment for age, central PWV correlated with fasting insulin (r2 = 0.45, P < 0.05) and autonomic score (r2 = 0.44, P < 0.05), peripheral PWV correlated with autonomic score (r2 = 0.51, P < 0.005) and IMT correlated with fasting insulin (r2 = 0.5, P < 0.005). The presence of autonomic neuropathy correlated with fasting insulin (P = 0.015), but not age, duration diabetes, lipids or blood pressure.Conclusion  Using repeatable measures of autonomic neuropathy and vascular function in Type 2 diabetic subjects, we have demonstrated associations between autonomic neuropathy, vascular dysfunction and hyperinsulinaemia. This may help to explain the excess cardiovascular mortality seen in diabetic subjects with autonomic neuropathy.

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Tài liệu tham khảo

10.2337/diab.23.2.105

10.1046/j.1464-5491.2001.00442.x

10.2337/diacare.24.10.1793

Ewing DJ, 1980, The natural history of diabetic autonomic neuropathy, Q J Med, 193, 95

10.1161/01.CIR.0000033824.02722.F7

10.1161/01.CIR.97.10.996

Haffner S, 1990, Cardiovascular risk factors in confirmed prediabetic individuals; does the clock for coronary heart disease start ticking before the onset of clinical diabetes?, JAMA, 263, 2893, 10.1001/jama.1990.03440210043030

10.1111/j.1464-5491.1993.tb00173.x

10.1161/01.CIR.83.3.945

10.1161/01.CIR.90.2.878

10.1111/j.1464-5491.1992.tb01746.x

10.1016/S0889-8529(05)70223-1

10.1161/hy0202.098325

10.1161/01.HYP.37.5.1236

10.1161/01.HYP.33.5.1111

10.1136/bmj.285.6346.916

10.1016/S0140-6736(86)90837-8

10.1080/13697130008500108

Liu Z, 1986, Estimation of total arterial compliance an improved method and evaluation of current methods, Am J Physiol, 251, H588

10.1161/01.ATV.18.7.1149

10.1161/01.CIR.88.4.1456

10.1161/01.ATV.11.6.1786

10.1161/01.STR.28.3.665

10.1161/01.STR.25.1.11

10.1046/j.1464-5491.2002.00664.x

10.1161/01.CIR.93.10.1809

10.2337/diacare.20.4.627

10.1161/01.CIR.99.18.2434

10.2337/diacare.22.11.1851

10.2337/diacare.11.10.787

10.1161/01.CIR.91.5.1432

10.1016/S0895-7061(01)02228-2

10.1046/j.1464-5491.1999.00079.x

10.1046/j.1464-5491.1999.00001.x

Toyry JP, 1996, Occurrence, predictors and clinical significance of autonomic neuropathy in NIDDM, Diabetes, 45, 308, 10.2337/diab.45.3.308

10.1016/0026-0495(88)90180-1

10.1007/BF00262020

10.1161/01.CIR.68.3.477

10.1161/01.HYP.35.4.892

10.1097/00004872-199305000-00015

10.1007/BF00877747

10.1097/00004872-199715120-00009

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Diabetic Medicine

Tập 21 Số 7

746-751

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