Intensive insulin therapy improves endothelial function and microvascular reactivity in young people with type 1 diabetes

Franklin, Victoria; Khan, Faisel; Kennedy, Gwen; Belch, J. J. F.; Greene, S A

doi:10.1007/s00125-007-0870-2

Cited by 40 publications

(25 citation statements)

References 29 publications

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“…Increased serum levels of sE-selectin have been reported in several connective tissue diseases [4], coronary heart disease [5] and systemic inflammatory response syndrome [6]. Moreover, it has been suggested that sE-selectin plays an important role in the pathogenesis of microvasculature disorders in diabetes [7]. A previous study demonstrated a relationship between sE-selectin serum concentration and microvascular abnormalities in nailfold capillaroscopy in patients with systemic lupus erythematosus (SLE) [8].…”

Section: Introductionmentioning

confidence: 99%

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy

Kuryliszyn-Moskal¹,

Dubicki²,

Zarzycki³

et al. 2011

Folia Histochem Cytobiol.

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Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of this study was to compare microvascular changes examined by nailfold capillaroscopy with serum concentrations of soluble E-selectin (sE-selectin) and IL-18 in type 1 diabetic patients with and without microangiopathy. Serum levels of sE-selectin and IL-18 were determined by an enzyme-linked immunosorbent assay in 106 patients with type 1 diabetes and in 40 healthy controls. All diabetic patients were evaluated by extensive clinical, laboratory and capillaroscopic studies. Morphological changes were observed by nailfold capillaroscopy in 86 out of 106 (81%) diabetic patients. Severe capillaroscopic changes were seen in 32 out of 54 (59%) patients with microangiopathy, but in only seven out of 52 (13%) patients without microangiopathy. Higher serum levels of sE-selectin (p < 0.001) and IL-18 (p < 0.05) were demonstrated in diabetic patients compared to controls. Significant differences of sE-selectin (p < 0.001) and IL-18 (p < 0.01) serum concentrations were observed between diabetic patients with microangiopathy and controls. Moreover, comparison between patients with and without microangiopathic complications showed a significantly higher capillaroscopic score and sE-selectin serum concentration in the group with microangiopathy (p < 0.001). Furthermore, diabetic patients with severe microvascular changes in capillaroscopy showed significantly higher IL-18 (p < 0.001) and sE-selectin (p < 0.05) serum levels than subgroups without changes or with mild abnormalities. Our findings suggest that abnormalities in nailfold capillaroscopy may reflect the extent of microvascular involvement and are associated with higher sE-selectin and IL-18 serum levels, as well as with microangiopathic complications in diabetic patients.

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Section: Introductionmentioning

confidence: 99%

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy

Kuryliszyn-Moskal¹,

Dubicki²,

Zarzycki³

et al. 2011

Folia Histochem Cytobiol.

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“…Conversely, extended follow-up of the trial with the biggest between-group difference in insulin use until now (the United Kingdom Prospective Diabetes Study [UKPDS]) revealed a 15% reduction in myocardial infarction and a 13% reduction in death among people with new-onset type 2 diabetes. 15 The UKPDS findings and the potential cardioprotective effects of insulin [16][17][18] suggest that early provision of sufficient basal insulin to normalize fasting plasma glucose levels may safely reduce incident cardiovascular outcomes. Evidence that exogenous insulin may slow the decline in pancreatic function with time [19][20][21] suggests that such an intervention may also reduce incident diabetes in people at risk for the disease.…”

mentioning

confidence: 99%

Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia

et al. 2012

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BACKGROUND: The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested. METHODS: We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of 95 mg per deciliter [5.3 mmol per liter]) or standard care and to receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial design. The results of the comparison between insulin glargine and standard care are reported here. The coprimary outcomes were nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes and these events plus revascularization or hospitalization for heart failure. Microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers were also compared between groups. RESULTS: The median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of incident cardiovascular outcomes were similar in the insulin-glargine and standard-care groups: 2.94 and 2.85 per 100 person-years, respectively, for the first coprimary outcome (hazard ratio, 1.02; 95% confidence interval [CI], 0.94 to 1.11; P=0.63) and 5.52 and 5.28 per 100 personyears, respectively, for the second coprimary outcome (hazard ratio, 1.04; 95% CI, 0.97 to 1.11; P=0.27). New diabetes was diagnosed approximately 3 months after therapy was stopped among 30% versus 35% of 1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI, 0.64 to 1.00; P=0.05). Rates of severe hypoglycemia were 1.00 versus 0.31 per 100 person-years. Median weight increased by 1.6 kg in the insulin-glargine group and fell by 0.5 kg in the standard-care group. There was no significant difference in cancers (hazard ratio, 1.00; 95% CI, 0.88 to 1.13; P=0.97). CONCLUSIONS: When used to target normal fasting plasma glucose levels for more than 6 years, insulin glargine had a neutral effect on cardiovascular outcomes and cancers. Although it reduced new-onset diabetes, insulin glargine also increased hypoglycemia and modestly increased weight. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT00069784.).

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“…Среди наиболее перспективных следует выделить изучение микроциркуляции в рамках ранней диагностики СД и его осложнений, уточнения риска развития осложнений, мониторинга эффективности ле-чения [35,36,37].…”

Section: применение лдф для оценки микроциркуляции у пациентов с сдunclassified

Prospects of Laser Doppler flowmetry application in assessment of skin microcirculation in diabetes

et al. 2017

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This review includes results of scientific and clinical use of laser Doppler flowmetry (LDF) in patients with diabetes mellitus. LDF is a non-invasive method for the quantitative evaluation of microcirculation, which can assess microcirculatory rhythms and conduct functional tests with various impacts, allowing the exploration of regulatory mechanisms of microcirculation. LDF reveals specific diabetes changes in the regulatory function of microcirculation. Microcirculation disturbances, which are traditionally associated with the pathogenesis of complications, also occur in patients with early disorders of carbohydrate metabolism and may precede the manifestation of diabetes. However, this method is still not applied in clinical practice. In this review, we analysed factors limiting the implementation of LDF in practical medicine and suggest ways to improve its clinical significance.

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Intensive insulin therapy improves endothelial function and microvascular reactivity in young people with type 1 diabetes

Abstract: Aims/hypothesis Macrovascular disease is an important cause of the increased morbidity and mortality rates associated with type 1 diabetes, and this vascular impairment begins in childhood.

Cited by 40 publications

References 29 publications

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy

Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia

Prospects of Laser Doppler flowmetry application in assessment of skin microcirculation in diabetes

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