Arterial wall stiffness is associated with peripheral circulation in patients with type 2 diabetes

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Scientific Institution “Research Institute for Complex Issues of Cardiovascular Diseases” The aim of this study was to evaluate the level of cardio-ankle vascular index (CAVI) in the presence of pre-diabetes and diabetes mellitus in the population sample of the Russian Federation, as well as to investigate the factors associated with pathological CAVI in these subjects. Methods 1628 (age 25-64 years) were recruited in a observational cross-sectional study ESSE-RF in the period from 2012 to 2013. The standard protocol of the ESSE-RF has been extended with additional study of CAVI. The final sample included 1617 people, they are divided into 3 groups: group 1 - patients with type 2 diabetes mellitus (n = 272), group 2 - patients with prediabetes - IFG, IGT or their combination (n = 44), and group 3 - persons without CMD (n = 1301). Results The median CAVI was higher in diabetes and pre-diabetes groups (p = 0.009 and p <0.001, respectively, compared with group without CMD). Pathological CAVI (≥9.0) was detected in 16.8% of diabetes patients, in 15.9% of those with prediabetes, and in 9.0% of those without CMD (p <0.001 when comparing diabetes group and group without CMD). The groups with diabetes and prediabetes also did not differ in factors affecting the level of arterial wall stiffness (gender, blood pressure, age, dyslipidemia, uric acid level). According to the result of the correlation analysis in the general sample, CAVI positively correlated with age (p <0.001), male sex (p <0.001), type 2 diabetes (p <0.001), prediabetes (p = 0.002), waist circumference (p <0.001), visceral obesity (p <0.001), total cholesterol (p <0.001), triglycerides (p <0.001), LDL cholesterol (p <0.001), and with the inverse correlation - with glomerular filtration rate (GFR, p <0.001). In multivariate analysis, age and the presence of arterial hypertension were independently associated with pathological CAVI in the groups of patients with CMD, and in the group without CMD, in addition to these factors - a decrease in GFR. Conclusions In the population sample of the Russian Federation, the CAVI index values in the prediabetes and diabetes patients were higher than in the normoglycemia persons. The groups with diabetes and prediabetes also did not differ in factors affecting the level of arterial wall stiffness. Since the identified disorders of arterial stiffness in prediabetes are similar to those in diabetes, their identification is important to prevent further cardiovascular complications.

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Correlation between arterial wall stiffness, N-terminal prohormone of brain natriuretic peptide, functional and structural myocardial abnormalities in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy

Diabetes Mellitus ◽

10.14341/dm2013472-77 ◽

2013 ◽

Vol 16 (4) ◽

pp. 72-77

Author(s):

Viktoriya Alexandrovna Serhiyenko ◽

Alexander Alexandrovich Serhiyenko ◽

Boris Nikitich Mankovsky

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Brain Natriuretic Peptide ◽

Plasma Levels ◽

Arterial Wall ◽

Vascular Wall ◽

Cardiac Autonomic Neuropathy ◽

Wall Stiffness

Aim. To assess arterial wall stiffness, plasma levels of of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as well as functional state and structure of the myocardium in patients with type 2 diabetes mellitus (T2DM) and cardiac autonomic neuropathy (CAN). Materials and Methods. The study involved a total of 65 patients with T2DM. 12 had no evidence of cardiovascular disease (CVD) or CAN, 14 were diagnosed with subclinical stage of CAN, 18 ? with functional stage, and 21 ? with organic stage. We measured aortic pulse wave velocity (PWV), aortic augmentation index (AIx), brachial artery AIx, ambulatory arterial stiffness index (AASI) and plasma levels of NT-proBNP. Clinical examination included ECG, Holter monitoring, ambulatory BP measurement and echocardiography. Results. Patients with isolated T2DM showed a trend for increased vascular wall stiffness. PWV was increased in patients with subclinical stage of CAN. Aortic and brachial AIx, PWV and AASI were elevated in patients with functional stage of CAN, PWV being significantly higher vs. subclinical CAN subgroup. Organic stage was characterized by pathologically increased values of all primary parameters; PWV and AASI were significantly higher compared with other groups. Development and progression of CAN was accompanied by an increase in NT-proBNP plasma levels. Concentration of NT-proBNP was in direct correlation with left ventricular mass (LVM) and PWV. PWV and LVM values also directly correlated between themselves. Conclusion. Development and progression of CAN in patients with T2DM is accompanied by an increase in vascular wall stiffness. The elevation of plasma NT-proBNP in patients with T2DM correlates with the development of CAN and is significantly and independently associated with an increase in LVM and PWV. Our data suggests the pathophysiological interconnection between metabolic, functional and structural myocardial abnormalities in patients with T2DM and CAN.

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Endothelial dysfunction and arterial wall stiffness: New targets in diabetic nephropathy

Terapevticheskii arkhiv ◽

10.17116/terarkh2017891087-94 ◽

2017 ◽

Vol 89 (10) ◽

pp. 87-94

Author(s):

I T Murkamilov ◽

I S Sabirov ◽

V V Fomin ◽

F A Yusupov

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Endothelial Dysfunction ◽

Kidney Disease ◽

Endothelial Function ◽

Arterial Wall ◽

Wall Stiffness

In recent years, one of the promising areas in clinical medicine is the study of impaired ments in endothelial function and arterial wall stiffness, which can be referred to as one of the important predictors of cardiovascular events in patients with chronic kidney disease, including that of diabetic etiology. There is strong evidence that endothelial function and great artery stiffness may be used as reliable clinical and instrumental indicators to evaluate the efficiency of therapeutic measures and the rate of progression of cardiovascular disorders in type 2 diabetes mellitus. The article presents data on the role of endothelial dysfunction and arterial wall stiffness in the progression of chronic kidney disease in type 2 diabetes mellitus and discusses the possibility of their correction with pharmacological agents.

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Cardio-ankle vascular index (CAVI) in diagnostics, risk and severity evaluation of magistral vessels lesion in patients with cardio-vascular diseases and type 2 diabetes

Terapevticheskii arkhiv ◽

10.26442/00403660.2021.01.200599 ◽

2021 ◽

Vol 93 (1) ◽

pp. 87-93

Author(s):

Vladimir A. Verner ◽

Maria V. Mel’nik ◽

Svetlana A. Knjazeva

Keyword(s):

Type 2 Diabetes ◽

Structural Changes ◽

Arterial Wall ◽

Vascular Diseases ◽

Chronic Hypertension ◽

Portable Devices ◽

Wall Stiffness ◽

Cardio Vascular ◽

Pressure Changes

Assesment of arterial stiffness the substantional prognostic factor for evaluating complications of cardiovascular diseases (CVD) in patients with atherosclerosis, hypertension and type 2 diabetes, may be performed using different parameters, including cardio-ankle vascular index (CAVI). The main purpose of this review is to analyze data from studies where CAVI is used to test the arterial wall stiffness in magistral vessels. CAVI measurement is non-invasive and performed by portable devices which makes it comfortable for ambulatory use in patients who come for a check-up and also in those who already are hospitalized. It does not require any special knowledge from investigator and the test lasts a couple of minutes long. CAVI does not depend on blood pressure changes and is more specific in structural changes of arterial wall assessment than brachial-ankle pulse wave velocity (baPWV). CAVI shows considerable correlation with markers of CVD like atherosclerotic plaques in vessels, diastolic disfunction of left ventricle and angina pectoris. CAVI may be used for early monitoring and assessing the lesions of target organs in patients with atherosclerosis, chronic hypertension and type 2 diabetes. Establishing CAVI as a standart parameter in assessing patients who are at risk of CVD can help to improve complications prevention, reduce mortality and prolong their lifespan.

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Peripheral Insulin Extraction in Non-Diabetic Subjects and Type 2 Diabetes Mellitus Patients

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-0808-4029 ◽

2018 ◽

Vol 128 (08) ◽

pp. 520-527

Author(s):

Daniël H. van Raalte ◽

Eva van der Palen ◽

Pauline Idema ◽

Liza Wong ◽

Sander W. M. Keet ◽

...

Keyword(s):

Type 2 Diabetes ◽

Peripheral Circulation ◽

Cross Sectional Study ◽

Capillary Endothelium ◽

Cross Sectional ◽

Insulin Levels ◽

Glucose Levels ◽

Novel Target ◽

Insulin Uptake

Abstract Background Insulin has to be transported across the capillary endothelium to stimulate muscle glucose uptake. We investigated insulin uptake from the peripheral circulation in non-diabetic (ND) individuals and in type 2 diabetes (T2D) patients. Methods Single-center cross-sectional study involving 40 ND (age 65±11 years) and 30 T2D patients (age 67±8 years). Thirty-six participants were studied in the fasted state (22 ND subjects and 14 T2D patients termed NDF and T2DF) and 34 participants 1-h following a glucose challenge (18 ND subjects and 16 T2D patients indicated as NDG and T2DG). Main outcome measure was fractional extraction (FE) of insulin (FEins) and glucose using the forearm balance method. Results In NDF, FEins was 18 (10–26) % at lower insulin levels (63 51–80] pmol/l), while in NDG at higher insulin levels (776 [543–1176] pmol/l), FEins was 9 (4–16) % (p = 0.01 vs. NDF). In NDF only, a negative correlation was observed between FEins and arterial plasma insulin load (rho = − 0.575;p = 0.006) and fasting plasma glucose levels (rho = − 0.551;p = 0.01). In T2DF FEins was 6 (1–19) % and not different from FEins in T2DG (10 2–14) %), and was not associated to fasting glucose. FEins tended to be higher in NDF compared to T2DF (p = 0.07). Discussion We propose that in ND individuals, besides passive diffusion, an active high-affinity pathway with limited capacity around lower physiologic insulin levels exists for insulin transendothelial transport, contributing to glycemic control. In T2D patients, this mechanism of peripheral insulin uptake is diminished or even absent. Modulation of insulin extraction from the circulation may be a novel target to improve glucose metabolism in T2D.

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SIRKULASI KAPILER KAKI PASIEN DIABETES MELLITUS TIPE-2 MELALUI RENDAM KAKI DENGAN MINYAK TANAH GARAM DINGIN DI PUSKESMAS BAITUSSALAM KABUPATEN ACEH BESAR

Sel Jurnal Penelitian Kesehatan ◽

10.22435/sel.v7i1.3564 ◽

2020 ◽

Vol 7 (1) ◽

pp. 41-51

Author(s):

Setio Budi Raharjo ◽

Amiruddin Amiruddin

Keyword(s):

Type 2 Diabetes ◽

Random Sampling ◽

Design Research ◽

Block Design ◽

Ankle Brachial Index ◽

Peripheral Circulation ◽

Control Group ◽

Type 2 Dm ◽

Randomized Block Design

Sirkuasi perifer kaki pasien DM Tipe 2 sangat tergantung pada nilai ankle brachial index (ABI). Untuk mengoptimalkan nilai ABI dalam batas normal, maka peneliti memberikan terapi non farmakalogi. Implementasi non farmakologi ini membantu meningkatkan sirkulasi perifer kaki dan bahan yang digunakan dalam penelitian ini adalah minyak tanah, garam dapur dan es batu. Penelitian menggunakan randomized block design research, terdiri dari 4 perlakuan dengan masing-masing perlakuan pada kelompok: A= hanya diberi minyak tanah (1 liter) sebagai kelompok kontrol; B=diberi minyak tanah 1 liter: 500 gram garam: 500 gram es batu; C= diberi minyak tanah 1 liter: 750 gram garam: 750 gram es batu; dan D= diberi minyak tanah 1 liter: 1 Kg garam: 1 Kg es batu. Random sampling dilakukan dengan komputer. Hasil penelitian diperoleh bahwa intervensi rendam kaki minyak tanah garam dingin yang memberikan dampak nyata pada nilai ABI pasien DM Tipe 2, yaitu perlakuan C yaitu rendam kaki dengan larutan 1 liter tanah: 750 gram garam: dan 750 gram es batu. Komposisi larutan yang paling berpengaruh terhadap perubahan nilai ABI pasien DM Tipe 2 adalah 1 liter minyak tanah: 750 gram garam: 750 gram es batu. Kesimpulan, penelitian ini telah menunjukkan bahwa sirkulasi perifer kaki pasien DM Tipe 2 dapat ditingkatkan melalui rendam kaki dengan minyak tanah garam dingin. Circulation of the peripheral feet of patients with Type 2 diabetes is very dependent on the value of the ankle brachial index (ABI). To optimize the ABI value within normal limits, the researchers provided nonpharmacological therapy. This nonpharmacological implementation helps improve the peripheral circulation of the feet and the materials used in this study are kerosene, table salt and ice cubes. The research used randomized block design research, consisting of 4 treatments with each treatment in the group: A = only given kerosene (1 liter) as a control group; B = oiled with 1 liter of soil: 500 grams of salt: 500 grams of ice cubes; C = oiled with 1 liter of soil: 750 grams of salt: 750 grams of ice cubes; and D = oiled with 1 liter of soil: 1 kg of salt: 1 kg of ice cubes. Random sampling is done by computer. The results showed that the cold salt kerosene foot soaking intervention had a significant impact on the ABI value of Type 2 DM patients, namely treatment C, namely soaking the feet with a solution of 1 liter of soil: 750 grams of salt: and 750 grams of ice cubes. The composition of the solution that most influences changes in the ABI value of Type 2 DM patients is 1 liter of kerosene: 750 grams of salt: 750 grams of ice cubes. Conclusion, this study has shown that the peripheral circulation of the feet of patients with type 2 diabetes can be improved by soaking the feet with cold salt kerosene.

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Presence of metabolic syndrome does not influence intima-media thickness and interadventitial diameter of main arteries in patients with type 2 diabetes mellitus

Kazan medical journal ◽

10.17816/kmj2018-235 ◽

2018 ◽

Vol 99 (2) ◽

pp. 235-239

Author(s):

R A Rzaeva

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Type 2 Diabetes Mellitus ◽

Carotid Arteries ◽

Intima Media Thickness ◽

Media Thickness ◽

Wall Stiffness ◽

Common Carotid Arteries

Aim. To evaluate intima-media thickness, interadventitial diameter of common carotid arteries and their ratio in patients with type 2 diabetes mellitus as well as in combination with metabolic syndrome, previously not receiving statins. Methods. The results of Doppler ultrasound of common carotid arteries of 233 patients were analyzed. 73 of them were diagnosed with type 2 diabetes (49 males, 24 females, average age 59.2±9.13 years), 74 - in combination with metabolic syndrome (38 males, 36 females, average age 61.38±9.16 years), and 86 did not have neither type 2 diabetes nor metabolic syndrome (52 males and 34 females, average age 58.99±7.23 years). For variables with normal distribution, mean value (M) and error of mean (m) were used, and when comparing nonparametric parameters, distribution in contingency table and χ2 was used. Results. Mean values of intima-media thickness of common carotid arteries and the ratio of intima-media thickness to interadventitial diameter were significantly higher (p <0.05), and interadventitial diameter was significantly lower (p <0.05) in the subgroups of patients with type 2 diabetes alone and in combination with metabolic syndrome compared to patients without these diseases. Significantly more frequently the cases of increased intima-media thickness and decreased interadventitial diameter of common carotid arteries were revealed on both sides in the subgroups with type 2 diabetes alone and combined with metabolic syndrome (p <0.001), that resulted in increased ratio of intima-media thickness to interadventitial diameter being indicative of general increase of arterial wall stiffness and decreased ability to compensatory remodeling in these categories of patients. Conclusion. In patients with type 2 diabetes mellitus and its combination with metabolic syndrome previously not receiving statins, the values of intima-media thickness, interadventitial diameter and their ratio statistically significantly differ frome those in patients without type 2 diabetes and metabolic syndrome; the presence of metabolic syndrome does not influence values of intima-media thickness, interadventitial diameter and their ratio in patients with type 2 diabetes mellitus.

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