Diabetic Retinopathy and Cerebral Hemodynamic Impairment in Type II Diabetes

Lippera, Stefano; Gregorio, F Di; Mg, Ceravolo; Lagalla, G.; Provinciali, Leandro

doi:10.1177/112067219700700207

Cited by 25 publications

(23 citation statements)

References 22 publications

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“…The PI of the MCA and ICA was increased only in complicated patients, whereas the PI in noncomplicated patients was comparable to that in control subjects. These results were quite consistent with those of Lippera et al 20 They demonstrated significantly increased pulsatility of the MCA in diabetic patients with retinopathy compared with those without retinopathy. However, most of their patients were hypertensive, and long-standing hypertension could also increase the pulsatility of the MCA and ICA, 32 as well as reduce cerebrovascular reactivity.…”

Section: Discussionsupporting

confidence: 83%

“…However, only a few studies have been performed in patients with DM. By using TCD, Lippera et al 20 demonstrated increased pulsatility and reduced cerebrovascular reactivity of the middle cerebral artery (MCA) in diabetic patients with retinopathy, but the effect of hypertension, a major factor also influencing cerebral hemodynamics, was not excluded. Fulesdi et al 21 also demonstrated a decrease of cerebrovascular reactivity of the MCA in normotensive patients with long-term type 1 DM.…”

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confidence: 99%

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Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes

Lee

Sohn

Baik

et al. 2000

Stroke

144

109

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Background and Purpose-This study was designed to evaluate cerebral hemodynamic changes related to diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). Methods-We measured the flow velocities and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA), extracranial internal carotid artery (ICA), and basilar artery (BA) in 56 stroke-free, normotensive patients with type 2 DM and 70 age-and gender-matched healthy volunteers. Patients were divided into 2 groups according to the presence of microvascular complications such as retinopathy, nephropathy, and neuropathy. Results-Patients showed slightly lower hematocrit and higher serum fibrinogen levels than control subjects, but other clinical profiles, including stroke risk factors except for diabetes, were comparable between patients and controls. The flow velocity of the ICA but not the MCA and BA in patients regardless of the complication was significantly higher than that in controls. The PIs of the MCA and ICA were significantly higher in patients with complication than those without complication, as well as in controls. The PI of the BA was also significantly higher, even in patients without complication, than in controls. The PIs of the MCA and ICA but not the BA were closely correlated with the duration of DM (r 2 ϭ0.46 and 0.34, respectively). Conclusions-This study defines TCD findings of diabetes-related cerebral hemodynamic changes and suggests that the PI reflects microangiopathic changes of cerebral vessels.

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Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes

Lee

Sohn

Baik

et al. 2000

Stroke

144

109

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show abstract

“…In patients with DM1, CVR has been shown to be decreased in patients with a long (>10–15 years) disease duration [3] and in those with autonomic neuropathy [4, 5]. Previous studies in DM2 patients have shown similar results, mostly reporting impaired CVR only in selected subgroups of patients with advanced complications or a long disease duration [6,7,8,9]. These findings may not be representative of the general DM2 population.…”

Section: Introductionsupporting

confidence: 64%

Cerebrovascular Reserve Capacity Is Preserved in a Population-Based Sample of Patients with Type 2 Diabetes Mellitus

Oers¹,

Manschot²,

Huffelen³

et al. 2006

Cerebrovasc Dis

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Background and Purpose: Type 2 diabetes mellitus (DM2) is associated with an increased risk of stroke. DM2 is also associated with cognitive impairments. Vascular dysfunction, such as impaired cerebrovascular reserve capacity (CVR), may be a determinant of these changes, but previous studies on CVR in DM2 have provided variable results in selected populations of patients. We aimed to examine CVR in a population-based sample of DM2 patients. Methods: The CO₂ reactivity of the middle cerebral artery was examined using transcranial Doppler ultrasonography in 81 DM2 patients and 38 controls. In DM2 patients CVR was correlated with diabetic parameters, vascular risk factors and cognitive functioning.Results: CVR was similar in patients and controls (51 vs. 49%). Within the DM2 group, there was no statistically significant relationship between CVR and DM duration, HbA_1c, albuminuria, blood pressure, intima-media thickness and cognition. CVR tended to be lower in diabetic patients with retinopathy [46 vs. 55%, mean difference: –7.9 (confidence interval –18.0, 2.2)]. Conclusion: We conclude that CVR is not impaired in unselected patients with DM2 and probably does not, therefore, play a major role in the aetiology of cognitive impairment.

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“…12,13,25 CVR appears to be reduced in patients with long-term insulindependent diabetes 11 and in those with proliferative diabetic retinopathy. 26 Furthermore, vasomotor tone appears to be increased in severe, noncontrolled hypertensives as compared with controlled hypertensives and normotensive subjects, and an inverse association was found between ACZ-CVR and the degree of echocardiographic left atrial enlargement. 12 CVR has also been noted to be markedly decreased in cerebrovascular diseases, especially in patients with large-vessel occlusive disease.…”

Section: Discussionmentioning

confidence: 99%

Impaired Cerebrovascular Reactivity as a Risk Marker for First-Ever Lacunar Infarction

Molina

Alvarez-Sabin

Montaner

et al. 1999

Stroke

112

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Background and Purpose-Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify the role of cerebrovascular reactivity (CVR) as a risk marker for first-ever symptomatic lacunar infarction. Methods-Forty-six patients with lacunar infarction and 46 sex-and age-matched control subjects were prospectively evaluated. Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. CVR was examined by calculating the percent increase in mean flow velocity occurring after 15 mg/kg acetazolamide administration (Diamox test). Results-CVR

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Diabetic Retinopathy and Cerebral Hemodynamic Impairment in Type II Diabetes

Abstract: These findings seem to confirm the hypothesis of a silent cerebral microangiopathy affecting diabetic patients, with concomitant signs of microangiopathic damage in other districts.

Cited by 25 publications

References 22 publications

Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes

Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes

Cerebrovascular Reserve Capacity Is Preserved in a Population-Based Sample of Patients with Type 2 Diabetes Mellitus

Impaired Cerebrovascular Reactivity as a Risk Marker for First-Ever Lacunar Infarction

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