Abstract
BackgroundDiabetes converts from a metabolic disorder into a predominantly vascular disease, once its duration extends over several years or/and when additional cardiovascular risk factors such as hypertension coexist. In a cross-sectional analysis we analyzed various vascular parameters in the renal, retinal and systemic circulation, with the goal to identify which vascular parameter of early organ damage is the earliest that can be clinically detected.MethodsIn 111 patients with type 2 diabetes (T2DM) (off any anti-diabetic medication for at least 4 weeks) and 54 subjects without T2DM we compared various parameters of early vascular remodeling in the same patient: urinary albumin creatinine ratio ([UACR], early morning spot urine) and estimated glomerular filtration rate (eGFR), retinal capillary flow (RCF) and intercapillary distance (ICD) as parameters of capillary rarefaction, wall-to-lumen ratio (WLR) of the retinal arterioles [all assessed by Scanning Laser Doppler Flowmetry], and central systolic pressure (cSBP) and central pulse pressure (cPP) [measured by pulse wave analysis, Syphygmocor] both reflecting vascular stiffness of large arteries.ResultsCompared to subjects without T2DM, patients with T2DM (diabetes duration: median 48 months, interquartile range 24–88 months) were older (59.8 ± 7.3 vs 43.4 ± 12.9 years, p < 0.001), more females (33.3 vs 20.4%, p < 0.001), but 24-h systolic and diastolic blood pressure did not differ between the two groups. The analysis adjusted for age, gender and cardiovascular risk factors revealed that ICD (23.9 ± 5.1 vs 20.8 ± 3.5 µm, p value = 0.001) and cPP (41.8 ± 11.7 vs 34.8 ± 10.6 mmHg, p value < 0.001) were significantly higher and eGFR (91.7 ± 9.9 vs 95.9 ± 17.3 ml/min/1.73 m2, p value < 0.001) was significantly lower in patients with T2DM than in subjects without T2DM.ConclusionThese data suggest that at similar blood pressure capillary rarefaction in the retinal circulation (ICD), decreased eGFR in the renal circulation and increased central pulse pressure (cPP) of large arteries are earlier detectable than other vascular remodeling parameters of the micro- (WLR, RCF, UACR) and macrocirculation (cSBP) in patients with T2DM.Trial registration Trial registration number: NCT02471963, Date of registration: June 15, 2015, retrospectively registered; Trial registration number: NCT01319357, Date of registration: March 21, 2011, retrospectively registered; Trial registration number: NCT02383238, Date of registration: March 9, 2015, retrospectively registered; Trial registration number: NCT00152698, Date of registration: September 9, 2005, prospectively registered; Trial registration number: NCT00136188, Date of registration: August 26, 2005, prospectively registered
Highlights
Diabetes converts from a metabolic disorder into a predominantly vascular disease, once its duration extends over several years or/and when additional cardiovascular risk factors such as hypertension coexist
Vascular assessment We assessed various microvascular parameters of retinal circulation [intercapillary distance (ICD), retinal capillary flow (RCF) and wall-to-lumen ratio (WLR)] and of renal circulation [estimated glomerular filtration rate and urinary albumin creatinine ratio (UACR)] as well as various macrovascular parameters of systemic circulation [central systolic pressure and central pulse pressure], both reflecting vascular stiffness of large arteries, with the goal to identify which vascular parameter of early organ damage is the earliest that can be clinically detected
Arterial hypertension was well controlled in subjects with type 2 diabetes mellitus (T2DM), who were treated with an average of 1.8 ± 0.9 antihypertensive medications
Summary
Diabetes converts from a metabolic disorder into a predominantly vascular disease, once its duration extends over several years or/and when additional cardiovascular risk factors such as hypertension coexist. The role of type 2 diabetes (T2DM) in the development of micro- and macrovascular complications of T2DM like nephropathy, retinopathy, coronary, cerebrovascular and peripheral artery disease has been well described. Numerous pathogenic mechanisms like endothelial dysfunction, inflammations and various metabolic factors beyond glucose levels contribute to these vascular complications in patients with T2DM [1, 2]. Detection of vascular remodeling and functional impairment in patients with T2DM is important to avoid the progression of vascular damage and irreversible complications. Even a mild stage of diabetic retinopathy is associated with higher risk of coronary heart disease and stroke independent of traditional risk factors [5,6,7]. The presence of any degree of diabetic retinopathy is linked with increased risk of all-cause mortality [8]
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