학술논문
Metabolic Factors Predict Changes in Endothelial Function During the Early Course of Type 1 and Type 2 Diabetes
Clinical Research Article
Clinical Research Article
Document Type
Clinical report
Author
Source
Journal of Clinical Endocrinology & Metabolism. October 2022, Vol. 107 Issue 10, pe4167, 10 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Endothelial dysfunction occurs frequently in persons with diabetes mellitus and is associated with increased cardiovascular risk in longstanding diabetes (1). Thus, assessment of endothelial function has been employed aiming at [...]
Context: Endothelial dysfunction may occur early in the development of cardiovascular and metabolic diseases; however, it remains often underestimated and studies rarely discriminate between diabetes types. We have examined endothelial function and its determinants during the early course of type 1 and type 2 diabetes. Methods: Caucasian participants of the prospective German Diabetes Study (GDS) with known diabetes duration Results: At baseline, neither FMD nor NMD differed between people with diabetes and the matched glucose-tolerant groups. At the 5-year follow-up, decline in FMD (-13.9%, P = .013) of persons with type 2 diabetes was independent of age, sex, and BMI, but associated with baseline adipose tissue insulin resistance and indices of liver fibrosis. The M-value decreased in both type 1 and type 2 diabetes groups by 24% and 15% (both P < .001, respectively) over 5 years. Higher HbA1c, lower M-value, and lower V[O.sub.2] max at baseline was associated with lower FMD in both type 1 and type 2 diabetes. Conclusion: Endothelial function decreases during the early course of type 2 diabetes. In addition to age and BMI, insulin sensitivity at diagnosis was the best predictor of progressive impairment in endothelial function in type 2 diabetes. Key Words: endothelial function, flow-mediated dilatation, nitroglycerin-mediated dilatation, insulin resistance Abbreviations: ABI, ankle--brachial index; ADIPO-IR, adipose-tissue insulin resistance index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; eGFR, estimated glomerular filtration rate; FFA, free fatty acids; FIB-4, fibrosis index; FLI, fatty liver index; FMD, flow-mediated dilation; GDS, German Diabetes Study; GGT, [gamma]-glutamyl transferase; HDL, high-density lipoprotein; hsCRP, high-sensitivity C-reactive protein; LDL, low-density lipoprotein; NAFLD, nonalcoholic fatty liver disease; NMD, nitroglycerin-mediated dilatation; NO, nitric oxide; T1D, type 1 diabetes; T2D, diabetes; V[O.sub.2]max, maximal oxygen consumption.
Context: Endothelial dysfunction may occur early in the development of cardiovascular and metabolic diseases; however, it remains often underestimated and studies rarely discriminate between diabetes types. We have examined endothelial function and its determinants during the early course of type 1 and type 2 diabetes. Methods: Caucasian participants of the prospective German Diabetes Study (GDS) with known diabetes duration Results: At baseline, neither FMD nor NMD differed between people with diabetes and the matched glucose-tolerant groups. At the 5-year follow-up, decline in FMD (-13.9%, P = .013) of persons with type 2 diabetes was independent of age, sex, and BMI, but associated with baseline adipose tissue insulin resistance and indices of liver fibrosis. The M-value decreased in both type 1 and type 2 diabetes groups by 24% and 15% (both P < .001, respectively) over 5 years. Higher HbA1c, lower M-value, and lower V[O.sub.2] max at baseline was associated with lower FMD in both type 1 and type 2 diabetes. Conclusion: Endothelial function decreases during the early course of type 2 diabetes. In addition to age and BMI, insulin sensitivity at diagnosis was the best predictor of progressive impairment in endothelial function in type 2 diabetes. Key Words: endothelial function, flow-mediated dilatation, nitroglycerin-mediated dilatation, insulin resistance Abbreviations: ABI, ankle--brachial index; ADIPO-IR, adipose-tissue insulin resistance index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; eGFR, estimated glomerular filtration rate; FFA, free fatty acids; FIB-4, fibrosis index; FLI, fatty liver index; FMD, flow-mediated dilation; GDS, German Diabetes Study; GGT, [gamma]-glutamyl transferase; HDL, high-density lipoprotein; hsCRP, high-sensitivity C-reactive protein; LDL, low-density lipoprotein; NAFLD, nonalcoholic fatty liver disease; NMD, nitroglycerin-mediated dilatation; NO, nitric oxide; T1D, type 1 diabetes; T2D, diabetes; V[O.sub.2]max, maximal oxygen consumption.