Endothelial and Autonomic Dysfunction at Early Stages of Glucose Intolerance and in Metabolic Syndrome

Abstract

This study evaluated sE-selectin, Endothelin-1, and cardiovascular autonomic neuropathy (CAN) at early stages of glucose intolerance and in metabolic syndrome (MetS). A total of 87 subjects – 39 males, of mean age 45.7±11.6 years and mean BMI 31.4±6.6 kg/m2, divided according to glucose tolerance and the presence of MetS were enrolled. Glucose tolerance was studied during OGTT. Anthropometric indices, blood pressure, HbA1c, lipids, hsCRP, sE-selectin, Endothelin-1, and immunoreactive insulin were measured. Body composition was assessed by a bioimpedance method (InBody 720, BioSpace). Tissue AGEs accumulation was evaluated by skin autofluorescence (AGE-Reader, DiagnOpticsTM). CAN was assessed by ANX-3.0 technology. In the groups, according to glucose tolerance, the prevalence of CAN was 5.7% in normal glucose tolerance (NGT), 8.6% in prediabetes, and 23.5% in newly diagnosed type 2 diabetes (NDD). In the groups, according to the presence of MetS, the prevalence of CAN was 12.3% in those with MetS and 4.8% in those without MetS. Parasympathetic activity was diminished at rest (p=0.048, 0.015, respectively) in NDD as compared to prediabetes and NGT; and there was a numerically elevated heart rate at rest in NDD in comparison to NGT. There was a negative correlation between parasympathetic tone and waist circumference, BMI, and visceral and total fat. There was no difference in the measured endothelial function markers in the groups according to glucose tolerance and MetS. sE-selectin correlated with HOMA-IR (r=0.275, p=0.048). No association between Endothelin-1 levels and assessed metabolic parameters was observed. There is a high prevalence of CAN at early stages of glucose intolerance and in MetS, due to decreased parasympathetic activity. Slight elevation of glycemia and MetS probably do not affect endothelial function, since sE-selectin seems to be related to insulin resistance.

Effects of high intensity interval training on neuro-cardiovascular dynamic changes and mitochondrial dysfunction induced by high-fat diet in rats

“…Once metabolic changes occur, as well as changes in the heart structure and myocardial function, the autonomic nervous system needs to act as a compensatory mechanism (feedback) to try to keep the physiological parameters within the normal range [ 38 , 39 ]. Since these parameters are affected by obesity, there is a development of autonomic dysfunction, an important factor in increasing the risk of sudden death in these subjects [ 40 ].…”

Chronic Microvascular Complications in Prediabetic States—An Overview

“…A number of studies have concerned the association between autonomic disfunction and prediabetes [ 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ] ( Table 3 ). A great diversity of results was observed in these studies when it comes to the discussed glucose metabolism disorders, the size of the groups undergoing research, and cardiovascular autonomic neuropathy (CAN) testing methods.…”

“…Nine studies followed IGT defined according to the WHO 1999 guidelines with 2-h post-load glucose levels between 140 and 199 mg/dL (7.8–11.0 mmol/L) in OGTT [ 78 , 81 , 84 , 85 , 86 , 87 , 88 , 89 ]. One study took into consideration an IFG-IGT group (defined according to ADA 2003 and WHO 1999 guidelines) [ 87 ], while two studies did not differentiate between these prediabetic states [ 90 , 91 ]. Seven studies included a small group (below 200 participants) [ 76 , 77 , 81 , 84 , 86 , 88 , 90 ], and six studies encompassed more than 1000 participants [ 76 , 79 , 80 , 82 , 83 , 91 ].…”

“…One study took into consideration an IFG-IGT group (defined according to ADA 2003 and WHO 1999 guidelines) [ 87 ], while two studies did not differentiate between these prediabetic states [ 90 , 91 ]. Seven studies included a small group (below 200 participants) [ 76 , 77 , 81 , 84 , 86 , 88 , 90 ], and six studies encompassed more than 1000 participants [ 76 , 79 , 80 , 82 , 83 , 91 ]. The size of groups undergoing research ranged from 80 to 9940.…”

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

“…Summary of studies The majority of studies were carried out in European populations (n = 7) [25,[36][37][38][39][40][41]; other locations were China (n = 1) [42], Brazil (n = 1) [43], USA (n = 1) [44] and Australia (n = 1) [45]. The studies sample sizes ranged from 52 to 1638 participants [25,[36][37][38][39][40][41][42][43][44][45][46][47]. All studies included tests of cardiac autonomic function.…”