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Simultaneous control of hyperglycemia and oxidative stress normalizes endothelial function in type 1 diabetes
Antonio Ceriello1, Sudhesh Kumar, Ludovica Piconi
1Centre of Excellence in Diabetes and Endocrinology, University Hospital of Coventry and Warwickshire, Warwick Medical School, University of Warwick, Coventry, UK. antonio.ceriello@warwick.ac.uk
Insights
In type 1 diabetes, combining insulin and vitamin C normalized endothelial dysfunction and oxidative stress. Neither treatment alone improved these markers, suggesting a synergistic effect for managing diabetic complications.
Area of Science:
- Endocrinology
- Vascular Biology
- Metabolic Diseases
Background:
- Endothelial dysfunction persists in type 1 diabetes despite normalized glycemia.
- Oxidative stress is a key mediator of hyperglycemia-induced endothelial dysfunction.
Purpose of the Study:
- To investigate the combined effect of insulin and vitamin C on endothelial dysfunction and oxidative stress in type 1 diabetes.
- To determine if normalizing glycemia alone or with vitamin C can reverse endothelial dysfunction.
Main Methods:
- Thirty-six type 1 diabetic patients and 12 controls were studied.
- Diabetic patients received insulin, vitamin C, or both for 24 hours.
- Endothelial function and oxidative stress markers were assessed.
Main Results:
- Neither insulin nor vitamin C alone normalized endothelial dysfunction or oxidative stress.
- Combined insulin and vitamin C treatment normalized both endothelial dysfunction and oxidative stress.
- Near-normalization of glycemia alone did not resolve endothelial dysfunction.
Conclusions:
- Long-lasting hyperglycemia in type 1 diabetes may cause permanent endothelial cell alterations.
- Increased oxidative stress contributes to persistent endothelial dysfunction.
- Combination therapy with insulin and vitamin C shows promise for managing endothelial dysfunction in type 1 diabetes.
Objective:
Previous studies have shown that in type 1 diabetes endothelial dysfunction persists even when glycemia is normalized. Moreover, oxidative stress has recently been demonstrated to be the mediator of hyperglycemia-induced endothelial dysfunction.
Research Design And Methods:
Thirty-six type 1 diabetic patients and 12 control subjects were enrolled. The diabetic patients were divided into three groups. The first group was treated for 24 h with insulin, achieving a near-normalization of glycemia. After 12 h of this treatment, vitamin C was added for the remaining 12 h. The second group was treated for 24 h with vitamin C. After 12 h of this treatment, insulin was started, with achievement of near-normalization of glycemia for the remaining 12 h. The third group was treated for 24 h with both vitamin C and insulin, achieving near-normalization of glycemia.
Results:
Neither normalization of glycemia nor vitamin C treatment alone was able to normalize endothelial dysfunction or oxidative stress. However, a combination of insulin and vitamin C normalized endothelial dysfunction and decreased oxidative stress to normal levels.
Conclusions:
This study suggests that long-lasting hyperglycemia in type 1 diabetic patients induces permanent alterations in endothelial cells, which may contribute to endothelial dysfunction by increased oxidative stress even when hyperglycemia is normalized.
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