Abnormal Cerebrovascular Carbon Dioxide Reactivity in People with Diabetes

Griffith, D N; Saimbi, S. S.; Lewis, Christopher Alan; Tolfree, S. E. J.; Betteridge, D. J.

doi:10.1111/j.1464-5491.1987.tb00865.x

Cited by 39 publications

(47 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding is inconsistent with those of Griffith et al 13 and Rodriguez et al 14 Rodriguez et al 14 reported that duration of diabetes, serum glucose concentration, and HbA1c did not correlate with the percentage of postacetazolamide global CBF changes. This discrepancy might be due in part to differences in demographic data.…”

Section: Kadoi Et Al Effects Of Diabetes Mellitus On Co 2 Reactivity contrasting

confidence: 67%

“…In regard to cerebrovascular CO 2 reactivity in diabetic patients, Griffith et al 13 reported that of 22 diabetic patients, 14 responded normally and 8 failed to show a significant increase in CBF after hypercapnia when the 133 Xe-clearance method was used. Dandona et al 2,3 reported that there was a significant variation in CBF after administration of 5% CO 2 in insulin-dependent diabetics compared with normal subjects using the 133 Xe-inhalation method, concluding that diabetics had diminished cerebrovascular reserve and were unable to compensate when necessary with an increased CBF.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diabetic Patients Have an Impaired Cerebral Vasodilatory Response to Hypercapnia Under Propofol Anesthesia

Kikuchi

Hara

Kunimoto

et al. 2003

Stroke

View full text Add to dashboard Cite

Background and Purpose-The purpose of this study was to examine the effects of diabetes mellitus and its severity on the cerebral vasodilatory response to hypercapnia. Methods-Thirty diabetic patients consecutively scheduled for elective major surgery were studied. After induction of anesthesia, a 2.5-MHz pulsed transcranial Doppler probe was attached to the patient's head at the right temporal window, and mean blood flow velocity of the middle cerebral artery (Vmca) was measured continuously. After the baseline Vmca, arterial blood gases, and cardiovascular hemodynamic values were measured, end-tidal CO 2 was increased by reducing ventilatory frequency by 2 to 5 breaths per minute. Measurements were repeated when end-tidal CO 2 increased and remained stable for 5 to 10 minutes. Results-Significant differences were observed in absolute and relative CO 2 reactivity between the diabetes and control groups (absolute CO 2 reactivity: control, 2.8Ϯ0.7; diabetes mellitus, 2.1Ϯ1.3; PϽ0.01; relative CO 2 reactivity: control, 6.3Ϯ1.4; diabetes mellitus, 4.5Ϯ2.7; PϽ0.01, Mann-Whitney U test). Significant differences were also found between diabetic patients with retinopathy and those without retinopathy in absolute (Pϭ0.002) and relative (Pϭ0.002) CO 2 reactivity, glycosylated hemoglobin (Pϭ0.0034), and fasting blood sugar (Pϭ0.01) (Scheffé's test, Mann-Whitney U test). There was an inverse correlation between absolute CO 2 reactivity and glycosylated hemoglobin (rϭ0.69, PϽ0.001). Conclusions-Insulin-dependent diabetic patients have an impaired vasodilatory response to hypercapnia compared with that of the control group, and the present findings suggest that their degree of impairment is related to the severity of diabetes mellitus.

show abstract

Section: Kadoi Et Al Effects Of Diabetes Mellitus On Co 2 Reactivity contrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Diabetic Patients Have an Impaired Cerebral Vasodilatory Response to Hypercapnia Under Propofol Anesthesia

Kikuchi

Hara

Kunimoto

et al. 2003

Stroke

View full text Add to dashboard Cite

show abstract

“…1 In diabetic humans as well as experimental animals, morphological abnormalities, including arterial endothelial cell necrosis and thickened capillary basement membranes, have been observed in small cerebral vessels. [7][8][9] Besides these morphological changes, diabetic patients have also shown impaired cerebrovascular reactivity to hypercapnia, 10,11 acetazolamide, 12 and blood pressure changes. 13,14 These vascular changes may alter cerebral blood flow (CBF) and eventually produce a stroke.…”

mentioning

confidence: 99%

Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes

Lee

Sohn

Baik

et al. 2000

Stroke

143

109

View full text Add to dashboard Cite

Background and Purpose-This study was designed to evaluate cerebral hemodynamic changes related to diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). Methods-We measured the flow velocities and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA), extracranial internal carotid artery (ICA), and basilar artery (BA) in 56 stroke-free, normotensive patients with type 2 DM and 70 age-and gender-matched healthy volunteers. Patients were divided into 2 groups according to the presence of microvascular complications such as retinopathy, nephropathy, and neuropathy. Results-Patients showed slightly lower hematocrit and higher serum fibrinogen levels than control subjects, but other clinical profiles, including stroke risk factors except for diabetes, were comparable between patients and controls. The flow velocity of the ICA but not the MCA and BA in patients regardless of the complication was significantly higher than that in controls. The PIs of the MCA and ICA were significantly higher in patients with complication than those without complication, as well as in controls. The PI of the BA was also significantly higher, even in patients without complication, than in controls. The PIs of the MCA and ICA but not the BA were closely correlated with the duration of DM (r 2 ϭ0.46 and 0.34, respectively). Conclusions-This study defines TCD findings of diabetes-related cerebral hemodynamic changes and suggests that the PI reflects microangiopathic changes of cerebral vessels.

show abstract

“…Thus, compared with healthy control subjects, young to middle-aged adults with type 1 diabetes show a modest but significant cognitive decline (2), and this can affect their quality of life. Neurophysiological or hemodynamic abnormalities in the central nervous system may occur before the clinical appearance of other diabetes complications (3,4) and before development of neurological dysfunction (5).…”

mentioning

confidence: 99%

“…In these studies, the increase in regional (5) or middle cerebral artery (7) blood flow following acetazolamide injection (5), carbon dioxide inhalation (4), or propofol anesthesia hypoventilation (7) was blunted. This sometimes occurred even in patients with no clinical evidence of vascular complications (4).…”

mentioning

confidence: 99%

Regional Cerebral Hemodynamic Response to Incremental Exercise Is Blunted in Poorly Controlled Patients With Uncomplicated Type 1 Diabetes

Tagougui

Fontaine²,

Leclair

et al. 2015

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVE Cerebral vasoreactivity to pharmacologically induced hypercapnia is impaired in poorly controlled patients with type 1 diabetes but otherwise free from microangiopathy. However, whether this response is also compromised during exercise, a daily-life physiological condition challenging regional cerebral hemodynamics, is unknown. We aimed to investigate prefrontal cortex hemodynamics during incremental maximal exercise in patients with uncomplicated type 1 diabetes, taking into account long-term glycemic control as well as exercise- and diabetes-influenced vasoactive stimuli. RESEARCH DESIGN AND METHODS Two groups of patients (type 1 diabetes with adequate glycemic control [T1D-A], n = 8, HbA1c 6.8 ± 0.7% [51 ± 7.7 mmol/mol]; type 1 diabetes with inadequate glycemic control [T1D-I], n = 10, HbA1c 9.0 ± 0.7% [75 ± 7.7 mmol/mol]) were compared with 18 healthy control subjects (CON-A and CON-I) matched for physical activity and body composition. Throughout exercise, near-infrared spectroscopy allowed investigation of changes in oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), and total hemoglobin (THb) in the prefrontal cortex. Venous and arterialized capillary blood was sampled during exercise to assess for factors that may alter prefrontal cortex hemodynamics and oxygenation. RESULTS No differences were observed between T1D-A and CON-A, but VO2max was impaired (P < 0.05) and cerebral blood volume (THb) increase blunted (P < 0.05) in T1D-I compared with CON-I. Nonetheless, O2Hb appeared unaltered in T1D-I probably partly due to blunting of simultaneous neuronal oxygen extraction (i.e., a lower HHb increase; P < 0.05). There were no intergroup differences in arterial oxygen content, Paco2, pH, [K+], and free insulin levels. CONCLUSIONS Maximal exercise highlights subtle disorders of both hemodynamics and neuronal oxygenation in the prefrontal cortex of poorly controlled patients with type 1 diabetes. These findings may warn clinicians of brain endothelial dysfunction occurring even before overt microangiopathy during exercise.

show abstract

Abnormal Cerebrovascular Carbon Dioxide Reactivity in People with Diabetes

Cited by 39 publications

References 22 publications

Diabetic Patients Have an Impaired Cerebral Vasodilatory Response to Hypercapnia Under Propofol Anesthesia

Diabetic Patients Have an Impaired Cerebral Vasodilatory Response to Hypercapnia Under Propofol Anesthesia

Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes

Regional Cerebral Hemodynamic Response to Incremental Exercise Is Blunted in Poorly Controlled Patients With Uncomplicated Type 1 Diabetes

Contact Info

Product

Resources

About