Reduced Venous Compliance in Young Women with Type 1 Diabetes - Further Aggravated by Prolonged Elevated Levels of HbA1c.

Marcus Lindenberger

doi:10.3389/fendo.2016.00126

Abstract

Young patients with diabetes present with reduced compensatory responses to hypovolemic stress. Less compliant veins could be a contributing factor, since roughly two-thirds of the blood volume resides in the venous system as a blood reservoir, adjusting proper venous inflow to the heart. The aim of this study was to measure venous compliance and lower limb blood pooling during hypovolemic stress, and to correlate them to indices of diabetes severity and glucose control. Fifteen young women with type 1 diabetes (DW) and 18 healthy age-matched women (C) were subjected to lower body negative pressure (LBNP) (11-44 mmHg), creating hypovolemic stress. Lower limb blood pooling was measured with strain gage technique and venous compliance calculated as the relationship between ∆V/∆P. DW presented with reduced blood pooling (e.g., blood pooling during LBNP of 44 mmHg, DW, 1.69 ± 0.10; C, 2.10 ± 0.08 (ml/100 ml), and P = 0.003). Calculated venous compliance was also reduced in DW (e.g., compliance at 20 mmHg, DW, 0.046 ± 0.003; C, 0.059 ± 0.002 (ml/100 ml/mmHg), and P = 0.002). A progressive reduction in both venous compliance (P < 0.007) and blood pooling (P < 0.005) was seen with increasing level of HbA1c, and furthermore, less strongly associated with presence of microvascular disease (signs of retinopathy). Women with type 1 diabetes present with both reduced venous compliance and blood pooling. The reductions were particularly present in patients with long-standing poor glycemic control.

Highlights

Orthostatic hypotension is more common in people with type 1 diabetes [1,2,3,4]
This indicates young women with diabetes as a interesting group to study. The aim of this present study was to assess venous compliance and lower limb blood pooling in healthy women and in young women with type 1 diabetes and, to correlate venous compliance with known risk factors associated with type 1 diabetes
Women with normal HbA1c the last years (HbA1c5) had significantly greater blood pooling during lower body negative pressure (LBNP) of 44 mmHg than women with moderate and severe HbA1c5 (P = 0.02 and P = 0.001, respectively), but no statistical differences were seen between the other three groups

Summary

Introduction

Orthostatic hypotension is more common in people with type 1 diabetes [1,2,3,4]. Diabetes is associated with hemodynamic instability and reduced tolerance to rapidly induced hypovolemia (e.g., during anesthesia) [1, 2, 5] and prolonged hypovolemia (e.g., hemodialysis) [6], aggravated with the presence of cardiovascular autonomic neuropathy (CAN) [2, 4, 5]. High vessel wall compliance is mandatory for efficient mobilization of peripheral venous capacitance blood to the central circulation to uphold venous return, cardiac output, and blood pressure during an orthostatic challenge [12, 13], We have recently presented reduced mobilization of peripheral capacitance blood in both men and women with type 1 diabetes [8, 14], aggravated with the severity of the disease, i.e., presence of microvascular disease [8] and level of HbA1c [14]. Reduced speed of initial blood pooling has been linked with orthostatic intolerance in women [17] This indicates young women with diabetes as a interesting group to study. The aim of this study was to measure venous compliance and lower limb blood pooling during hypovolemic stress, and to correlate them to indices of diabetes severity and glucose control

Objectives

Methods

Results

Discussion

Conclusion