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Lifetime glycaemic exposure predicts reduced coronary vasoreactivity in Type 1 diabetic subjects

J Sundell1, T Janatuinen, T Rönnemaa

  • 1Turku PET Centre, University of Turku, FIN-2052 Turku, Finland. jan.sundell@utu.fi

Diabetic Medicine : a Journal of the British Diabetic Association
|December 21, 2004
PubMed

Insights

Lifetime glycemic exposure, measured by glycosylated hemoglobin A1c (HbA1c) over months, significantly impacts coronary vasoreactivity in Type 1 diabetes. Poor long-term glycemic control is linked to reduced myocardial blood flow, an early sign of coronary artery disease.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Type 1 diabetes is associated with impaired coronary vasoreactivity.
  • The specific impact of long-term glycemic control on myocardial perfusion in Type 1 diabetes remains unclear.

Purpose of the Study:

  • To investigate the effect of lifetime glycemic exposure on coronary vasoreactivity in Type 1 diabetic individuals.
  • To differentiate the impact of long-term versus recent glycemic control on myocardial blood flow.

Main Methods:

  • Positron emission tomography (PET) with (15)O-water was used to measure myocardial blood flow.
  • Coronary vasoreactivity was assessed during pharmacologically induced hyperemia in fasting and hyperinsulinemic clamp states.
  • Lifetime glycemic exposure was quantified using glycosylated hemoglobin A1c (HbA1c) over months.

Main Results:

  • Hyperemic myocardial blood flow showed a significant inverse correlation with log HbA1c (lifetime glycemic exposure) in both fasting (r = -0.72, P < 0.01) and clamp states (r = -0.35, P < 0.05).
  • These correlations persisted after adjusting for cardiovascular risk factors including lipids, blood pressure, BMI, and age.
  • No significant association was found between hyperemic flow and recent HbA1c or plasma glucose levels.

Conclusions:

  • Lifetime glycemic exposure is a stronger predictor of reduced coronary vasoreactivity than recent glycemic control in Type 1 diabetes.
  • Diminished coronary vasoreactivity in Type 1 diabetics with poor glycemic control may indicate early coronary artery disease development.
Abstract

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