Microvascular reactivity in type 1 diabetics

Abstract

Objective: To evaluate whether differences are present in microvascular response to the schemia induced by dynamic videocapillaroscopy (VCD), through analysis of the measured capillar transverse segment area (CTSA) in patients with type 1 diabetes mellitus (T1DM). Methods: The vascular reactivity of the CTSA was studied by VCD, using a reactive hyperemia test in 61 volunteers, being 31 healthy controls without diabetes family history (Group 1) and 30 patients with T1DM without complications (Group 2). The images were captured every two seconds, during reperfusion after one minute induced ischaemia, and they were analyzed by the program Studio Version 8 and Motic Image Plus. The pre-ischemia capillary transverse segment (basal area, BA), the maximum strain post-ischemia (maximum area, MA), and time to achieve it (MAt) were measured during reperfusion, and the increased area percentage (Ap) was estimated. Results: The mean differences between groups were evaluated by the t-test. The median comparisons between the groups were studied by the Mann-Whitney test. There was no difference in BA between the groups. The Ap was significantly lower among the diabetic patients, and there was a significant increase in the Mat among the patients of Group 2 when compared to Group 1. Conclusions: These data suggest that type 1 diabetes provokes earlier endothelial dysfunction, before the onset of clinically detectable degenerative complications. The outcomes from these alterations need further studies. Arq Bras Endocrinol Metab. 2009;53(6):741-6 Keywords Diabetes mellitus; microcirculation; angioscopy microscopy; endothelium-abnormalities RESUMO Objetivo: Avaliar se há diferença de resposta microcirculatória à isquemia induzida pela videocapilaroscopia dinâmica (VCD), por meio da análise de medida da área do segmento transverso capilar (ASTC) em pacientes com diabetes melito tipo 1 (DMT1). Métodos: A reatividade vascular do ASTC foi estudada pela VCD usando o teste de hiperemia reativa em 61 voluntários, sendo 31 controles sadios sem história familiar de diabetes (Grupo 1) e 30 pacientes com DMT1, sem complicações (Grupo 2). As imagens foram capturadas a cada dois segundos, durante a reperfusão após um minuto de isquemia induzida, e analisadas pelo programa Studio Version 8 e Motic Image Plus. O segmento transverso pré-isquemia (área basal, AB), a área máxima pós-isquemia (área máxima, AM) e o tempo para alcançá-la foram medidos durante a reperfusão, e o percentual de incremento foi estimado. Resultados: As principais diferenças entre os grupos foram avaliadas pelo teste t. As médias comparativas entre os grupos foram avaliadas pelo teste Mann-Whitney. Não houve diferença na área basal entre os dois grupos. O percentual de incremento foi significativamente menor entre os pacientes diabéticos e houve um aumento significativo no ASTC entre os pacientes do Grupo 2 quando comparados com o Grupo 1. Conclusões: Os dados sugerem que o diabetes tipo 1 provoca disfunção endotelial precoce, antes mesmo de complicações degenerativas...

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