Partial Restoration of Scintigraphically Assessed Cardiac Sympathetic Denervation in Newly Diagnosed Patients with Insulin-dependent (Type 1) Diabetes Mellitus at One-year Follow-up

Schnell, Oliver; Muhr, Daniela; Dresel, S.; Weiss, Murray J.; Haslbeck, M.; Standl, Eberhard

doi:10.1002/(sici)1096-9136(199701)14:1<57::aid-dia297>3.0.co;2-7

Cited by 32 publications

(25 citation statements)

References 3 publications

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“…4 Also, a decrease in sympathetic activity has been shown in the early phase of human diabetes. 5,6 In the present study, arterial NE concentration, which reflects whole-body sympathetic tone, was significantly decreased in patients with noncomplicated type 1 diabetes. Our findings may seem to contradict results reported by others, who reported normal or even increased NE levels in normoalbuminuric type 1 DP.…”

Section: Vervoort Et Al Blood Flow In Type 1 Diabetes: No and Sympathsupporting

confidence: 53%

Elevated Skeletal Muscle Blood Flow in Noncomplicated Type 1 Diabetes Mellitus

Vervoort¹,

Wetzels²,

Lutterman³

et al. 1999

Hypertension

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Abstract-Capillary hyperperfusion precedes and contributes to the occurrence of diabetic microangiopathy. Vascular tone is regulated by the balance of vasodilating and vasoconstricting factors, of which nitric oxide (NO; an endothelium dependent vasodilator) and norepinephrine (NE; a potent vasoconstrictor), respectively, are of primary importance. To investigate the role of these factors in hyperperfusion, we measured forearm blood flow (FBF) in 50 patients with noncomplicated type 1 diabetes (DP) and 50 healthy control subjects (CS) under baseline conditions and during intrabrachial infusion of N G -monomethyl-L-arginine (L-NMMA), an endothelium-dependent vasoconstrictor, and acetylcholine (ACh), an endothelium-dependent vasodilator. Furthermore, we determined arterial plasma NE concentration at baseline and then determined ␣-adrenergic receptor sensitivity by measuring FBF response to intra-arterially infused NE. We found that basal FBF was increased in DP (2.9Ϯ0.1 versus 2.0Ϯ0.1 mL ⅐ min Ϫ1 ⅐ dL Ϫ1 in CS; PϽ0.01). L-NMMA caused a similar vasoconstriction in both groups (28.5Ϯ1.7% in DP versus 31.2Ϯ2.2% in CS; PϭNS). Maximum blood flow during infusion of ACh was not different (23.3Ϯ1.9 mL ⅐ min Ϫ1 ⅐ dL Ϫ1 in DP versus 20.1Ϯ1.6 in CS). Arterial plasma NE concentrations were significantly decreased in DP (0.57Ϯ0.03 versus 0.81Ϯ0.05 nmol/L in CS; PϽ0.01). The vasoconstrictive effect of NE was increased in DP (slope log dose-response curve, 31.3Ϯ1.5 versus 24.3Ϯ1.8 in CS; PϽ0.01). We conclude that basal FBF is increased in noncomplicated type 1 diabetes. We found no evidence of a disturbance of basal or stimulated NO production. Arterial plasma NE concentrations are decreased in noncomplicated type 1 diabetes. This may explain the vasodilatation at baseline and the increased vascular response to intra-arterially NE. (Hypertension. 1999;34:1080-1085.)

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Section: Vervoort Et Al Blood Flow In Type 1 Diabetes: No and Sympathsupporting

confidence: 53%

Elevated Skeletal Muscle Blood Flow in Noncomplicated Type 1 Diabetes Mellitus

Vervoort¹,

Wetzels²,

Lutterman³

et al. 1999

Hypertension

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“…In newly diagnosed, metabolically stabilized Type I diabetic patients, improvement of metabolic control to near-normoglycaemia with intensive insulin therapy has been observed to result in a reduction of cardiac sympathetic dysinnervation in the posterior and septal myocardial region at 1-year follow-up [85]. Of the diabetic patients 69 % still had cardiac sympathetic defects at 1 year [85].…”

Section: Secondary Prevention Of Cardiac Dysfunctionmentioning

confidence: 99%

“…Of the diabetic patients 69 % still had cardiac sympathetic defects at 1 year [85]. In poorly controlled long-duration Type I diabetic patients with mean HbA 1 c values over 11 %, substantial improvement of metabolic control (mean HbA 1 c 7.3 % at 1 year) partially restores global and anterior, posterior and septal cardiac sympathetic innervation [86].…”

Section: Secondary Prevention Of Cardiac Dysfunctionmentioning

confidence: 99%

A new look at the heart in diabetes mellitus: from ailing to failing

Standl

Schnell

2000

Diabetologia

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“…Bei neu entdeckten Typ-1-Diabetikern ergaben szintigraphische Untersuchungen mit dem Noradrenalinanalogon 123 I-MIBG, dass eine intensivierte Insulintherapie partiell zu einer Verbesserung der kardialen sympathischen Funktion führt [14]. Insbesondere im Bereich der Herzhinterwand wurde eine Verbesserung der sympathischen Herzfunktion beobachtet [14].…”

Section: Diskussionunclassified

“…Insbesondere im Bereich der Herzhinterwand wurde eine Verbesserung der sympathischen Herzfunktion beobachtet [14]. Auch bei langjährigen Typ-1-Diabetikern, die eine ungünsti-ge Stoffwechseleinstellung (HbA 1c > 10%) aufweisen, führt die intensivierte Insulintherapie mit Optimierung der Stoffwechsellage zu einer Verbesserung der Herzinnervation [15].…”

Section: Diskussionunclassified