Weight change and sulfonylurea therapy are related to 3 year change in microvascular function in people with type 2 diabetes
| Autor: | Philip E Gates, Christine Anning, D Mawson, Angela C. Shore, Kunihiko Aizawa, Kim M Gooding, Francesco Casanova, Damilola D Adingupu, W. David Strain, C. I. Ball |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Nitroprusside medicine.medical_specialty Weight loss Epidemiology Endocrinology Diabetes and Metabolism Population 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents education Cause of death Aged education.field_of_study business.industry Microcirculation Weight change Diabetes Middle Aged medicine.disease Acetylcholine Vasodilation Sulfonylurea Compounds Diabetes Mellitus Type 2 Cardiology Quality of Life Female Sodium nitroprusside Endothelium Vascular Microvascular medicine.symptom business Weight gain medicine.drug |
| Zdroj: | Diabetologia |
| ISSN: | 1432-0428 |
| Popis: | Aims/hypothesis Although cardiovascular disease is the biggest cause of death in people with diabetes, microvascular complications have a significant impact on quality of life and financial burden of the disease. Little is known about the progression of microvascular dysfunction in the early stages of type 2 diabetes before the occurrence of clinically apparent complications. We aimed to explore the determinants of endothelial-dependent and -independent microvascular function progression over a 3 year period, in people with and without both diabetes and few clinical microvascular complications. Methods Demographics were collected in 154 participants with type 2 diabetes and in a further 99 participants without type 2 diabetes. Skin microvascular endothelium-dependent response to iontophoresis of acetylcholine and endothelium-independent responses to sodium nitroprusside were measured using laser Doppler fluximetry. All assessments were repeated 3 years later. Results People with type 2 diabetes had impaired endothelial-dependent microvascular response compared with those without (AUC 93.9 [95% CI 88.1, 99.4] vs 111.9 [102.3, 121.4] arbitrary units [AU] × min, p p = 0.002). Mean microvascular function declined over 3 years in both groups to a similar degree (pinteraction 0.74 for response to acetylcholine and 0.69 for response to sodium nitroprusside). In those with diabetes, use of sulfonylurea was associated with greater decline (p = 0.022 after adjustment for co-prescriptions, change in HbA1c and weight), whereas improving glycaemic control was associated with less decline of endothelial-dependent microvascular function (p = 0.03). Otherwise, the determinants of microvascular decline were similar in those with and without diabetes. The principal determinant of change in microvascular function in the whole population was weight change over 3 years, such that those that lost ≥5% weight had very little decline in either endothelial-dependent or -independent function compared with those that were weight stable, whereas those who gained weight had a greater decline in function (change in endothelial-dependent function was 1.2 [95% CI −13.2, 15.7] AU × min in those who lost weight; −15.8 [−10.5, −21.0] AU × min in those with stable weight; and −37.8 [−19.4, −56.2] AU × min in those with weight gain; ptrend Conclusions/interpretation Over 3 years, physiological change in weight was the greatest predictor of change in microvascular function. |
| Databáze: | OpenAIRE |
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