Vessel wall stiffness in type 1 diabetes and the central hemodynamic effects of acute hypoglycemia

Abstract

Compared with age- and sex-matched nondiabetic controls, people who had type 1 diabetes for a long duration had increased stiffness of vessel walls. The opposing responses in peripheral and central systolic pressures during hypoglycemia may be related to the reduction in AIx, which causes diminished amplification of the systolic pressure wave. Changes in AIx are probably mediated by a direct action of insulin on arterial endothelium, or changes in heart rate. These functional changes may contribute to the increased cardiovascular morbidity that is associated with type 1 diabetes of long duration.

Assessment of arterial stiffness in type 1 diabetes using digital pulse contour analysis: Is it a reliable method?

“…Surprisingly, there were no differences between the SI and RI in patients with T1DM compared with the control group, in contrast with a majority of studies reporting increased arterial stiffness in T1DM patients [12,14,21]. This discrepancy might reflect the fact that most of these studies were performed using a reduced sample size with respect to the present study.…”

“…In the present study, the SI was associated with diabetes duration, DBP, and HDL cholesterol, showing that diabetes duration is the only independent variable associated with the SI. There is compelling evidence suggesting that in T1DM patients with longer disease duration, arterial stiffness occurs due to the calcification of inferior limbs arteries [11,14,15]. Diabetes duration that is of great interest when studying patients with T1DM seemed to affect SI in this group, although disclosing no differences among groups, what can be explained by other factors that are discussed below.…”

Hypoglycemia and Cardiovascular Risk: Is There a Major Link?

“…Acute hypoglycemia provokes a substantial rise in myocardial contractility (16) and cardiac output (17). These hemodynamic changes are accompanied by an increase in elasticity of large blood vessels and a fall in central arterial pressure, with both measures being diminished in young men with type 1 diabetes of long duration (.15 years) in whom arterial stiffness has developed (18). A recent analysis of coronary artery calcification scores in patients with type 1 diabetes suggested an association of higher scoresdindicating a higher degree of calcification and hence arterial stiffnessdwith a higher rate of severe hypoglycemia (19).…”

Cardiovascular Implications of Hypoglycemia in Diabetes Mellitus

“…The direct effects of hypoglycemia on endothelial function are less well established. Sommerfield et al 15 show in a cohort of subjects with type 1 diabetes mellitus that hypoglycemia resulted in a reduction in arterial wall stiffness and augmentation index, probably as a result insulin-induced changes in the arterial endothelium. Although this in isolation may not represent a major risk factor for cardiovascular disease, hypoglycemia-induced endothelial dysfunction may act in concert with inflammatory biomarkers and blood coagulation abnormalities to promote cardiovascular events.…”