Influence of Postprandial Hyperglycemic Conditions on Arterial Stiffness in Patients With Type 2 Diabetes
Daniel Gordin1, Markku Saraheimo1, Jaana Tuomikangas1
1Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia.
Context:
Patients with type 2 diabetes (T2D) are at an increased risk of cardiovascular disease.
Objective:
The objective of the study was to determine whether postprandial hyperglycemia affects arterial function in T2D.
Design:
A single-center, open-label study of three groups of men were studied: 1) T2D patients with albuminuria (n = 22), 2) T2D patients without albuminuria (n = 24), and 3) nondiabetic controls (n = 25). Patients were randomized to a two-period crossover study schedule, ingesting breakfast, with or without insulin lispro (to induce low or high postprandial glycemia).
Main Outcome Measures:
Arterial stiffness was assessed by calculating pulse wave velocity (PWV) and augmentation index using applanation tonometry, and endothelial dysfunction was assessed using peripheral arterial tonometry, 30 minutes before breakfast and up to 240 minutes after breakfast.
Results:
At baseline, arterial stiffness was increased in patients. When adjusted for age and body mass index, in a combined group of patients with and without albuminuria, brachial PWV was higher during low (P = .032) and high (P = .038) postprandial glycemia vs controls. These differences were driven by the albuminuria group vs controls during low (P = .014) and high (P = .018) postprandial glycemia. No differences were observed in aortic PWV, augmentation index, or peripheral arterial tonometry ratio between patients and controls. Endothelin-1 and IL-6 were higher, and superoxide dismutase was lower, during postprandial hyperglycemia in T2D patients vs controls.
Conclusions:
In patients with T2D and albuminuria, brachial PWV was higher under postprandial hyperglycemic conditions, relative to controls. These data suggest that hyperglycemia induces an increase in stiffness of intermediate-sized arteries. We found no changes in other parts of the arterial bed.
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