Abstract
AimsInsulin possesses both vasodilatory and sympathomimetic activities. The aim was to examine the relationship between changes in insulin exposure and arterial stiffness in type 2 diabetes (T2D).MethodsPatients with T2D with (n = 22) or without (n = 24) albuminuria, and non-diabetic controls (n = 25) were randomized to a crossover study having a breakfast with or without pre-meal rapid-acting insulin. Pulse wave velocity (PWV) was measured at 30 min before and at 60-min intervals up to 240 min after the breakfast.ResultsAt baseline, both postprandial aortic (p = 0.022) and brachial (p = 0.011) PWV were higher in individuals with T2D than in healthy controls irrespective of the presence of albuminuria. In patients with albuminuria, weight-adjusted insulin dose correlated inversely with the excursion of the aortic (r = − 0.412, p = 0.006) and brachial (r = − 0.372; p = 0.014) PWV. Similarly, circulating endogenous insulin concentrations correlated inversely with the aortic (r = − 0.347, p = 0.026) and brachial (r = − 0.622, p = <0.001) PWV. No correlations between insulin and PWV were observed in patients without albuminuria or in healthy controls.ConclusionsThe inverse correlation between insulin and PWV in T2D with albuminuria may reflect a vasorelaxing effect of insulin.Clinical trial registration numberThe study was registered (clinicaltrials.gov) with the identifier of NCT01159938.
Highlights
The role of insulin in enhancing peripheral blood flow as well as increasing arterial diameter in large arteries is well established [1,2,3]
We have previously shown that postprandial hyperglycemia increases brachial pulse wave velocity (PWV) in albuminuric but not in normoalbuminuric patients with type 2 diabetes (T2D) [9]
We observed an inverse correlation between insulin and PWV in the T2D patients with but not without albuminuria or in healthy controls
Summary
The role of insulin in enhancing peripheral blood flow as well as increasing arterial diameter in large arteries is well established [1,2,3]. Acta Diabetologica (2019) 56:1169–1175 blocked by inhibiting nitric oxide synthesis highlighting the endothelial effects of insulin [4]. It is not known if the vasodilatory effect of insulin is preserved in patients with diabetic complications. An open but important question is whether albuminuria, which is often related to autonomous neuropathy and endothelial dysfunction, influences the effect of insulin on blood flow and/or arterial stiffness [5,6,7,8]. We analyzed whether there is any association between postprandial hyperinsulinemia and the stiffness of large (aortic) and middle-sized (brachial) arteries in individuals with T2D, and if so, are there differences between T2D patients with or without albuminuria
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