Abstract
Background:
Microcirculatory and endothelial dysfunction are signs of cardiovascular engagement in patients with type 2 diabetes. This study tested whether glucose normalisation may reverse this.
Methods:
Thirty-nine T2DM patients (age 61±7 years, 58% females) with signs of mild diastolic dysfunction were randomised to strict glucose control based on insulin (I-group; n=21) or oral agents (O-group; n=18) for four months. Skin microcirculation was studied with laser Doppler fluxmetry and endothelial function with brachial artery flow-mediated dilatation.
Results:
Glucose control improved (reduction of HbA(1c) I-group = -0.5%; O-group -0.7%; p=0.69). Microcirculation improved in the entire group (n=39) determined by foot laser Doppler fluxmetry (32.2±13.6 vs. 35.3±13.1 perfusion units; p<0.001) and laser Doppler fluxmetry following heating (68.8±34.0 vs. 69.3±25.1 PU; p=0.007). Improvement was more consistent with oral agents than insulin. Endothelial function expressed as flow-mediated dilatation decreased in the I-group (6.0±2.2 to 4.7±3.0%; p=0.037) but remained unchanged in the O-group (4.8±2.3 to 5.0±3.7%; n.s.).
Conclusions:
Glycaemic normalisation improved skin microcirculation but not endothelial function in patients with type 2 diabetes with mild cardiovascular engagement.
Publication types
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Randomized Controlled Trial
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Research Support, Non-U.S. Gov't
MeSH terms
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Administration, Oral
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Aged
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Biomarkers / blood
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Blood Glucose / drug effects*
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Blood Glucose / metabolism
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Brachial Artery / drug effects
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Brachial Artery / physiopathology
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Carbamates / therapeutic use
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Diabetes Mellitus, Type 2 / blood
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Diabetes Mellitus, Type 2 / complications
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Diabetes Mellitus, Type 2 / drug therapy*
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Diabetes Mellitus, Type 2 / physiopathology
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Diabetic Angiopathies / blood
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Diabetic Angiopathies / drug therapy*
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Diabetic Angiopathies / etiology
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Diabetic Angiopathies / physiopathology
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Diastole*
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Female
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Glycated Hemoglobin / metabolism
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Humans
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Hypoglycemic Agents / administration & dosage
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Hypoglycemic Agents / therapeutic use*
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Insulin Aspart / therapeutic use
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Insulin Glargine
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Insulin, Long-Acting / therapeutic use
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Laser-Doppler Flowmetry
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Male
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Metformin / therapeutic use
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Microcirculation / drug effects*
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Middle Aged
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Piperidines / therapeutic use
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Prospective Studies
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Regional Blood Flow / drug effects
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Skin / blood supply*
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Sweden
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Time Factors
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Treatment Outcome
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Vasodilation / drug effects
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Ventricular Dysfunction / etiology
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Ventricular Dysfunction / physiopathology*
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Ventricular Function*
Substances
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Biomarkers
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Blood Glucose
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Carbamates
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Glycated Hemoglobin A
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Hypoglycemic Agents
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Insulin, Long-Acting
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Piperidines
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hemoglobin A1c protein, human
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Insulin Glargine
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repaglinide
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Metformin
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Insulin Aspart