Progression of large artery structural and functional alterations in Type I diabetes

Giannattasio, Cristina; Failla, Monica; Grappiolo, Alessandra; Gamba, Pierluigi; Paleari, F.; Mancia, Giuseppe

doi:10.1007/s001250051600

Cited by 68 publications

(54 citation statements)

References 21 publications

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“…In type 1 diabetes CIMT is increased compared to matched healthy controls. Determinants of CIMT in type 1 diabetes are similar to subjects without diabetes [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

et al. 2005

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Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a potential confounder. Methods: An observational study was performed in 215 subjects with type 1 diabetes treated with multiple insulin injection therapy. Atherosclerosis was assessed by measurement of carotid intima-media thickness (CIMT). Results: The cumulative dose of regular insulin showed a positive and significant relation with CIMT: increase of 21 m in CIMT per S.D. of insulin use (95% CI: 8-35 adjusted for gender and age), which remained unchanged after adjustment for duration of diabetes, HbA1c, BMI, pulse pressure, physical activity and carotid lumen diameter. A similar relation was found for intermediate-acting insulin: 15.5 m per S.D. (2-29), which was no longer present after further adjustment. Conclusions: These findings provide evidence that a high cumulative dose of regular insulin is a risk factor for atherosclerosis.

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“…In type 1 diabetes CIMT is increased compared to matched healthy controls. Determinants of CIMT in type 1 diabetes are similar to subjects without diabetes [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

et al. 2005

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“…In non-diabetic subjects, age, male gender, hypertenThe mortality and morbidity from cardiovascular disease is two to four times higher in patients with Type I sion, smoking, impaired fibrinolysis, hypercholesterolaemia, and mild hyperglycaemia seem to be independent predictors of IMT [7,8,9,10,11,12]. In cross-sectional studies, carotid IMT has been increased in Type I diabetic patients compared with matched control subjects [13] already at a young age [14], and in the absence of overt macrovascular disease [15]. Multivariate analyses have shown that maximum or mean IMT of proximal carotid artery are independently associated with age [13,14,16,17,18,19], duration of diabetes [13], male gender [13,19], triglycerides [13], total and LDL cholesterol [18], nephropathy [13], hypertension [18,19,20], height [16], BMI [16], HbA 1c [17], and smoking [16] in patients with Type I diabetes.…”

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confidence: 96%

Family histories of Type II diabetes and hypertension predict intima–media thickness in patients with Type I diabetes

et al. 2002

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Aims/hypothesis. Hyperglycaemia predicts microvascular complications but data on macrovascular disease are limited. We searched for predictors of carotid artery intima-media thickness in young adults with Type I (insulin-dependent) diabetes mellitus. Methods. A total of 71 children (F/M = 34/37) were followed after their diagnosis until they reached 32 ± 1 years of age, when duration of diabetes averaged 22 ± 1 years. Cardiovascular risk markers [lipids, blood pressure, smoking, urinary albumin excretion rate, lifetime glycaemic exposure (A 1c months), exercise habits, alcohol consumption, family history] were evaluated at age 21 ± 1 for the baseline examination and at age 32 ± 1 years for the follow-up examination years. During follow-up, intima-media thickness of common and internal carotid arteries and the carotid bulb were quantitated using a high-resolution B-mode ultrasound.Results. In univariate analysis, age, BMI, blood pressure, lifetime glycaemic exposure, a positive family history of Type II (non-insulin-dependent) diabetes mellitus, hypertension and cardiovascular disease were predictors of carotid intima-media thickness. In multivariate analysis, a positive family history of Type II diabetes predicted maximal (p < 0.05) and common (p < 0.005) carotid artery intima-media thickness, family history of hypertension predicted increases in maximal (p < 0.04), and far wall (p < 0.006) carotid artery intima-media thickness, and lifetime glycaemic exposure was an independent predictor of increased carotid bulb thickness (p < 0.03). Conclusion/interpretation. Positive family histories of Type II diabetes and hypertension are independent predictors of carotid intima-media thickness in patients with Type I diabetes, and could therefore predispose these patients to atherosclerosis [Diabetologia (2002) 45:711-718]

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“…A few studies have shown that patients with type 1 diabetes have stiffer arteries than non-diabetic individuals [19][20][21][22][23][24][25][26]. However, the patient groups in these studies were heterogeneous and a wide range of methodologies and techniques was used.…”

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confidence: 99%

Acute hyperglycaemia rapidly increases arterial stiffness in young patients with type 1 diabetes

et al. 2007

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Aims/hypothesis Augmentation index (AIx) and pulse wave velocity (PWV), both measures of arterial stiffness, constitute risk factors for cardiovascular disease. Notably, hyperglycaemia during an acute cardiovascular event is associated with poor prognosis. The objective of this study was to investigate whether acute hyperglycaemia increases arterial stiffness in patients with type 1 diabetes and in healthy subjects. Methods Twenty-two male patients with type 1 diabetes and thirteen healthy men, who were age-matched nonsmokers and without any diabetic complications, underwent a 120 min hyperglycaemic clamp (15 mmol/l). AIx was calculated to assess arterial stiffness. Before and during the clamp, carotid-radial (brachial) and carotid-femoral (aortic) PWV was measured. Results At baseline there was a difference in the AIx between patients with type 1 diabetes and healthy volunteers (−5±2.7 vs −20±2.8%, p<0.05). Acute hyperglycaemia rapidly increased AIx in patients with type 1 diabetes (−5±2.7 vs 8±2.5%, p<0.001) and healthy volunteers (−20±2.8 vs 6±8.8%, p<0.001). Brachial PWV increased during acute hyperglycaemia in patients with type 1 diabetes (7.1±1.2 vs 8.0±1.0 m/s, p<0.001), but not in healthy men (7.4±1.7 vs 7.3±1.4 m/s, NS). Conclusions/interpretation Acute hyperglycaemia increases the stiffness of intermediate-sized arteries and resistance arteries in young patients with type 1 diabetes and consequently emphasises the importance of strict daily glycaemic control. No change was observed in aortic PWV during the clamp, indicating that acute hyperglycaemia does not affect the large vessels.

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Progression of large artery structural and functional alterations in Type I diabetes

Cited by 68 publications

References 21 publications

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

Family histories of Type II diabetes and hypertension predict intima–media thickness in patients with Type I diabetes

Acute hyperglycaemia rapidly increases arterial stiffness in young patients with type 1 diabetes

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