Abstract
ObjectiveImpaired cerebral vasomotor reactivity (VMR) and flow-mediated dilation (FMD) were found in selected subgroups of type 2 diabetes mellitus (T2DM) patients with long-term disease. Our study aimed to evaluate cerebral hemodynamics, systemic endothelial function and sympatho-vagal balance in a selected population of well-controlled T2DM patients with short-term disease and without cardiac autonomic neuropathy (CAN).Research Design and MethodsTwenty-six T2DM patients with short-term (4.40±4.80 years) and well-controlled (HbA1C = 6.71±1.29%) disease, without any complications, treated with diet and/or metformin, were consecutively recruited. Eighteen controls, comparable by sex and age, were enrolled also.ResultsFMD and shear rate FMD were found to be reduced in T2DM subjects with short-term disease (8.5% SD 3.5 and 2.5 SD 1.3, respectively) compared to controls (15.4% SD 4.1 and 3.5 SD 1.4; p<.001 and p<.05). T2DM patients also displayed reduced VMR values than controls (39.4% SD 12.4 vs 51.7%, SD 15.5; p<.05). Sympatho-vagal balance was not different in T2DM patients compared to healthy subjects. FMD and shear rate FMD did not correlate with VMR in T2DM patients or in controls (p>.05).ConclusionsIn well-controlled T2DM patients with short-term disease cerebral hemodynamics and systemic endothelial function are altered while autonomic balance appeared to be preserved.
Highlights
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular and cerebrovascular diseases with high mortality and disability
flowmediated dilation (FMD) and shear rate FMD were found to be reduced in T2DM subjects with short-term disease (8.5% SD 3.5 and 2.5 SD 1.3, respectively) compared to controls (15.4% SD 4.1 and 3.5 SD 1.4; p,.001 and p,.05)
FMD and shear rate FMD did not correlate with vasomotor reactivity (VMR) in T2DM patients or in controls (p..05)
Summary
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular and cerebrovascular diseases with high mortality and disability. Cerebral vasomotor reactivity (VMR), one of the most accurate markers of cerebral hemodynamics, has been shown to be impaired in subjects with carotid artery stenoocclusive disease and associated with an increased risk of ischemic events [1,2,3]. VMR was normal in unselected patients [9], and no data are available in wellcontrolled patients with short-term disease. These controversial results are likely due to the heterogeneity of the studied populations, since it is well known that the degree of metabolic control and the presence of diabetic complications strongly contribute to determine the different phenotypes of type 2 diabetic patients. High frequency (HF) component is mainly influenced by vagal activity and low frequency both by sympathetic and parasympathetic ones, the LF/HF ratio is considered a reliable index of sympathovagal balance in humans
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