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- Title
The Nature of Microcirculatory Abnormalities in Patients with Microvascular Complications.
- Authors
Brooks, Belinda A.; Mclennan, Susan; Twigg, Stephen M.; Yue, Dennis K.
- Abstract
Endothelial dysfunction in macrovascular disease is well characterised by measurement of in vivo arterial blood flow and various biomarkers. In contrast, abnormalities of microvascular blood flow and biomarkers in the development of microvascular complications is less well documented. The aim of this study was to characterise microvascular blood flow and biomarkers in patients with type 2 diabetes with (D+ve Comps) and without (D-ve Comps) microvascular complications. We recruited 20 D+ve Comps [Age: 55 yrs (IQR 49 - 62), BMI: 32.6 ± 6.6 kg/m², Duration: 14.1 ± 6.2 yrs, HbA1c: 8.2% (IQR 7.5 - 9.2)], 20 D-ve Comps [Age: 58 yrs (IQR 54 - 64), BMI. 28.6 ± 4.8 kg/m², Duration: 5.8 ± 4.8 yrs, HbA1c: 6.4% (IQR 6.3 - 7.2)] and 20 age matched control subjects [Age: 56 yrs (IQR 47 - 61), BMI: 27.4 ± 4.0 kg/m²]. Patients with a history of macrovascular event were excluded. Blood was collected for biomarkers: C reactive protein (hsCRP), PAI-1 and the adhesion molecules sICAM and sVCAM. Skin blood flow (SkBF) of the forearm was measured using laser Doppler Velocimetry (LDV) combined with iontophoresis of acetycholine (ACh; endothelium dependent) and sodium nitroprusside (SNP; endothelium independent). Results are expressed as mean ± SD or median (interquartile range), and SkBF as fold increase from baseline. Both ACh and SNP responses progressively fall with development of diabetes and complications. There was a significant overall correlation between ACh and SNP responses (r=0.7, p<0.0001), but this relationship was more evident in control subjects and those with complications. We conclude that abnormalities of microvascular blood flow become progressively evident in parallel with the development of microvascular diabetic complications. This relationship was stronger than that pertaining to conventional biomarkers of vascular disease and inflammation. As both ACh and SNP responses became attenuated, the disturbance is not characteristic of endothelial dysfunction alone but could also be due to excessive quenching of NO or defective vascular smooth muscle response to NO, or to factors such as stiffness of the microvessels.
- Subjects
DIABETES complications; BLOOD flow; BIOMARKERS; TYPE 2 diabetes; MICROCIRCULATION disorders; PEOPLE with diabetes; VASCULAR diseases
- Publication
Diabetes, 2007, Vol 56, pA212
- ISSN
0012-1797
- Publication type
Article