ENDOTHELIAL FUNCTION, AS ASSESSED BY FLOW MEDIATED DILATION AND ASYMMETRIC DIMETHYLARGININE IS IMPAIRED IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS

Abstract

Objective: Endothelial dysfunction precedes the onset of clinically detectable atherosclerosis diabetes mellitus in type 2 (T2DM) and contributes significantly to the development of vascular complications and mortality. The aim of the present study was to investigate the endothelial function in patients with a recent diagnosis of T2DM. Design and method: We studied patients with newly diagnosed T2DM (<6 months from diagnosis) that did not receive antidiabetic treatment (except for metformin) and otherwise healthy individuals matched for age and blood pressure (BP). We recorded somatometric, BP (office and 24-hour) and hematological (lipids, renal function, fasting glucose, HBA1c) data. We also calculate the 10-year atherosclerotic cardiovascular risk (ASCVD risk score). We determined endothelial dysfunction with 2 methods: Asymmetric Dimethylarginine (ADMA) by ELISA (enzyme-linked immunosorbent assay) and the gold standard non-invasive method Flow Mediated Dilation (FMD). Results: Ninety subjects were studied, 33 patients with T2DM and 57 controls. Twenty T2DM patients were enrolled within 1 month from diagnosis, while the rest 13 had been diagnosed 3.69±2.14 months before. Similarly, 16 (48.48%) had received metformin for a median of 3 (interquartile range 18) weeks. T2DM showed significantly impaired FMD [4.68 (4.58)% versus 7.85 (7)%, (p = 0.012)] and higher ADMA [0.926±0.569 μmol/l versus 0.468 (0.27) μmol/l, (p = 0.032)], compared to controls. There was also an independent association of T2DM and FMD (Beta = -0.278, p = 0.012). Results were similar in the sub-group analysis of patients without hypertension. In this cohort, FMD lower than 7.5% was able to predict T2DM diagnosis with 87.5% sensitivity and 70.8% specificity. Conclusions: Patients with a very recent diagnosis of T2DM show impaired endothelial function as demonstrated by FMD and ADMA findings. This assessment highlights the early severe, damaging effect of hyperglycemia on the endothelium, emphasizing the need for early detection and management.