The Relationship between TNF-a, IL-35, VEGF and Cutaneous Microvascular Dysfunction in Young Patients with Uncomplicated Type 1 Diabetes

Abstract

The aim of this study was to analyze the relationship between immunological markers and the dysfunction of cutaneous microcirculation in young patients with type 1 diabetes. The study group consisted of 46 young patients with type 1 diabetes and no associated complications. Microvascular function was assessed with the use of nail fold capillaroscopy before and after implementing post-occlusive reactive hyperemia. This evaluation was then repeated after 12 months. Patients were divided into two subgroups according to their baseline median coverage (defined as the ratio of capillary surface area to surface area of the image area), which was established during the initial exam (coverageBASE). Additionally, the levels of several serum biomarkers, including VEGF, TNF-a and IL-35, were assessed at the time of the initial examination. HbA1c levels obtained at baseline and after a 12-month interval were also obtained. Mean HbA1c levels obtained during the first two years of the course of the disease were also analyzed. Patients with coverageBASE below 16.85% were found to have higher levels of VEGF and TNF-α, as well as higher levels of HbA1c during the first two years following diabetes diagnosis. Our results support the hypothesis that the development of diabetic complications is strongly influenced by metabolic memory and an imbalance of pro- and anti-inflammatory cytokines, regardless of achieving adequate glycemic control.

The Impact of Disease Duration on Microcirculatory Dysfunction in Young Patients with Uncomplicated Type 1 Diabetes

“…Similarly, the study by Gasser et al [68] showed no correlation between the degree of metabolic control in diabetes and capillaroscopic parameters. Neubauer-Geryk [53], in their study of a group of adult patients with T1D, also found no relationship between cutaneous microvascular reactivity and metabolic control reflected by HbA 1c levels.…”

“…Capillaroscopy during the test was performed twice: after 20 min of rest in a sitting position and after 4 min of active occlusion induced by an arm compression with a sphygmomanometer cuff at a pressure higher than the patient's systolic pressure by 50 mmHg. Additionally, we have previously studied the reproducibility of capillaroscopy and have described our approach in detail in a separate report [52,53].…”

“…Additionally, we have previously studied the reproducibility of capillaroscopy and have described our approach in detail in a separate report [52,53].…”

Gender-Related Difference in Skin Oxygenation in Young Patients with Uncomplicated Type 1 Diabetes

“…Capillaroscopy was performed according to a procedure we described many times previously [26,31,34,37,53]. In brief, capillaroscopy was performed for the evaluation of the nail bed capillaries of fingers II-V of both upper limbs.…”

“…In previous reports, we presented the results of our studies on the structure and function of the cutaneous microcirculation with the use of capillaroscopy and transcutaneous oxygen pressure (TcPO2) [26,31,52,53]. In the study of microcirculation in diabetic patients without microangiopathy, it is important to be aware of possible physiological differences.…”