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Endothelial dysfunction in Type 2 diabetic subjects with and without microalbuminuria
D R Meeking1, M H Cummings, S Thorne
1Department of Diabetes, Queen Alexandra Hospital, Portsmouth, UK.
Diabetic Medicine : a Journal of the British Diabetic Association
|November 5, 1999
Summary
Endothelial dysfunction is present in Type 1 diabetes, even before microalbuminuria develops, indicating an increased risk for coronary artery disease. Low levels of active transforming growth factor-beta are linked to this dysfunction.
Area of Science:
- Cardiovascular Research
- Endocrinology
- Nephrology
Background:
- Endothelial dysfunction is a key factor in the development of cardiovascular disease.
- Microalbuminuria is an early sign of kidney damage in diabetes, often associated with increased cardiovascular risk.
- The relationship between microalbuminuria, endothelial dysfunction, and cardiovascular risk markers in Type 1 diabetes requires further elucidation.
Purpose of the Study:
- To investigate the association between microalbuminuria and endothelial dysfunction in patients with Type 1 diabetes mellitus.
- To explore the relationship between biochemical markers of cardiovascular risk and endothelial dysfunction in this patient group.
Main Methods:
- Utilized high-resolution ultrasound to measure brachial artery vasodilatory responses (endothelium-dependent and -independent) in three groups: Type 1 diabetic patients with microalbuminuria, normoalbuminuric Type 1 diabetic patients, and non-diabetic controls.
- Assessed flow-mediated dilation (FMD) and glyceryl trinitrate (GTN)-mediated dilation.
- Measured urinary albumin-creatinine ratio, glycosylated hemoglobin, plasma glucose, lipid profiles, and active transforming growth factor (TGF)-beta concentrations.
Main Results:
- Significantly reduced FMD was observed in both microalbuminuric and normoalbuminuric diabetic patients compared to controls, indicating endothelial dysfunction.
- No significant difference in FMD was found between the microalbuminuric and normoalbuminuric diabetic groups.
- FMD did not correlate with urinary albumin-creatinine ratio or common glycemic/lipid markers, but showed a positive correlation with active TGF-beta levels.
- GTN-mediated dilation was positively associated with HDL-cholesterol but not with active TGF-beta or other biochemical markers.
Conclusions:
- Endothelial dysfunction is prevalent in Type 1 diabetes, irrespective of microalbuminuria status, suggesting it precedes the development of microalbuminuria as a cardiovascular risk marker.
- Low plasma levels of active TGF-beta are associated with impaired endothelial function in Type 1 diabetes.
- Active TGF-beta may serve as a potential biomarker for identifying Type 1 diabetic patients at higher risk of coronary artery disease.