We conclude that a consensus concerning the assessment of IMT is urgently needed. Variability of IMT measurements is lowest when determining the mean thickness in the common carotid artery in different directions.

Plasma Levels of Cellular Fibronectin in DiabetesOBJECTIVE -Cellular fibronectin is an endothelium-derived protein involved in subendothelial matrix assembly. Elevated plasma levels of cellular fibronectin therefore reflect loss of endothelial cell polarization or injury to blood vessels. Consequently, elevated plasma levels of circulating cellular fibronectin have been described in clinical syndromes with vascular damage, although not in diabetes or atherosclerosis.RESEARCH DESIGN AND METHODS -We determined fibronectin levels in 52 patients with type 1 diabetes, 50 patients with type 2 diabetes, 54 patients with a history of ischemic stroke, 23 patients with renal artery stenosis, and 64 healthy subjects.RESULTS -Circulating cellular fibronectin was significantly elevated in patients with diabetes (4.3 ± 2.8 µg/ml) compared with patients with ischemic stroke (2.0 ± 0.9 µg/ml), patients with renovascular hypertension (1.7 ± 1.1 µg/ml), and healthy subjects (1.4 ± 0.6 µg/ml). Patients with diabetes and at least one cardiovascular risk factor had an almost 2.5-fold increase in cellular fibronectin compared with diabetic subjects without such a risk factor. In multivariate regression analysis, higher triglycerides, current or past cigarette smoking, and higher urinary albumin excretion were independently associated with an increase in circulating cellular fibronectin in diabetes.CONCLUSIONS -These results suggest that circulating cellular fibronectin may be a marker protein for endothelial cell activation, especially in diabetes. Prospective studies are needed to explore this possibility.

Our study demonstrates that reproducibility of measurements of IMT and arterial distensibility of the common carotid artery, by B-mode and M-mode ultrasonography respectively, is acceptable when used in large studies.

This angiographic study confirms the clinical notion that lower limb atherosclerosis in diabetes is more severe in distal segments of the lower extremity, while the proximal segments remain less attenuated compared with patients without diabetes.

In general, intima-media thickness is larger in type II diabetes than in type I diabetes. The effect of age is absent in type II diabetes, whereas in type I diabetes, age and blood glucose control have an important effect on intima-media thickness.