The impact of cardiovascular co-morbidities and duration of diabetes on the association between microvascular function and glycaemic control

Abstract

BackgroundGood glycaemic control in type 2 diabetes (T2DM) protects the microcirculation. Current guidelines suggest glycaemic targets be relaxed in advanced diabetes. We explored whether disease duration or pre-existing macrovascular complications attenuated the association between hyperglycaemia and microvascular function.Methods743 participants with T2DM (n = 222), cardiovascular disease (CVD = 183), both (n = 177) or neither (controls = 161) from two centres in the UK, underwent standard clinical measures and endothelial dependent (ACh) and independent (SNP) microvascular function assessment using laser Doppler imaging.ResultsPeople with T2DM and CVD had attenuated ACh and SNP responses compared to controls. This was additive in those with both (ANOVA p < 0.001). In regression models, cardiovascular risk factors accounted for attenuated ACh and SNP responses in CVD, whereas HbA1c accounted for the effects of T2DM. HbA1c was associated with ACh and SNP response after adjustment for cardiovascular risk factors (adjusted standardised beta (β) −0.096, p = <0.008 and −0.135, p < 0.001, respectively). Pre-existing CVD did not modify this association (β −0.099; p = 0.006 and −0.138; p < 0.001, respectively). Duration of diabetes accounted for the association between HbA1c and ACh (β −0.043; p = 0.3), but not between HbA1c and SNP (β −0.105; p = 0.02).ConclusionsIn those with T2DM and CVD, good glycaemic control is still associated with better microvascular function, whereas in those with prolonged disease this association is lost. This suggests duration of diabetes may be a better surrogate for “advanced disease” than concomitant CVD, although this requires prospective validation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-017-0594-7) contains supplementary material, which is available to authorized users.

Metformin and aspirin treatment could lead to an improved survival rate for Type 2 diabetic patients with stage II and III colorectal adenocarcinoma relative to non-diabetic patients

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“…The use of laser Doppler fluximetry with iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) enables mechanistic studies to non-invasively elucidate endothelialdependent and -independent effects [13,14]. Skin microvascular responses have been demonstrated to be reduced in people with type 2 diabetes [7], and associated with left ventricular hypertrophy [15], urinary AER [16], retinopathy [17], coronary artery disease [18] and symptomatic angina independent of atherosclerosis [19]. A recent systematic review and network analysis found progressive microvascular impairment across the spectrum of metabolic health, from a healthy population to those with obesity, glucose impairment and diabetes mellitus [20].…”

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