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Capillary pressure in patients with NIDDM
A C Shore1, A J Jaap, J E Tooke
1Department of Vascular Medicine, Postgraduate Medical School, University of Exeter, U.K.
Insights
Capillary pressure was not elevated in patients with non-insulin-dependent diabetes mellitus (NIDDM), contrary to findings in insulin-dependent diabetes. This suggests different mechanisms in diabetic microangiopathy pathogenesis.
Area of Science:
- Endocrinology
- Vascular Biology
- Diabetology
Background:
- Diabetic microangiopathy is a complication of diabetes mellitus.
- The hemodynamic hypothesis posits raised capillary pressure in its pathogenesis.
- Differences in microvascular complications between insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) suggest varied pathogenic mechanisms.
Purpose of the Study:
- To investigate whether capillary pressure is elevated in patients with NIDDM.
- To compare capillary pressure in NIDDM patients with healthy controls.
Main Methods:
- Finger nailfold capillary pressure was measured in 21 NIDDM patients and 21 matched healthy controls.
- Measurements were taken using direct cannulation of capillary loops with glass micropipettes.
- Groups were matched for age, sex, skin temperature, systolic blood pressure, and diastolic blood pressure.
Main Results:
- Capillary pressure did not significantly differ between NIDDM patients (17.6 mmHg) and control subjects (19.1 mmHg).
- No correlation was found between capillary pressure and HbA1c or glucose levels.
- A negative association was observed between capillary pressure and diabetes duration (Rs = -0.50, P = 0.020).
Conclusions:
- Raised capillary pressure is not a feature of NIDDM, unlike in IDDM.
- The pathogenesis of microvascular complications in NIDDM may involve mechanisms other than elevated capillary pressure.
Abstract:
The hemodynamic hypothesis suggests that raised capillary pressure may play a role in the pathogenesis of diabetic microangiopathy. Although patients with non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes NIDDM) develop a similar range of microvascular complications, differences in their expression and prevalence suggest that different pathogenic mechanisms may be operational. Capillary pressure is elevated in IDDM; the aim of this study was to assess whether capillary pressure was also elevated in NIDDM. Twenty-one patients with NIDDM (15 men) and 21 healthy control subjects matched for age, sex, and skin temperature were investigated supine with the hand at heart level. Finger nailfold capillary pressure was measured after direct cannulation at the summit of the capillary loops using glass micropipettes. The groups were matched for skin temperature (30.4 [24.2-33.8] degrees C, median [95% confidence interval], NIDDM patients vs. 30.0 [23.4-33.6] degrees C control subjects), age (62.0 [39.4-72.7] years NIDDM patients vs. 62.0 [39.4-72.0] years control subjects), and both systolic (sBP) and diastolic (dBP) blood pressures (133.0 [111.0-167.3]/78.0 [57.0-89.5] mmHg NIDDM patients vs. 133.0 [114.1-158.9]/80.0 [68.2-88.9] mmHg control subjects). Capillary pressure did not differ in the two groups (17.6 [13.1-21.2] mmHg NIDDM patients vs. 19.1 [14.1-23.6] mmHg control subjects [NS]). There was no correlation of capillary pressure with either HbA1c or glucose; however, there was a negative association between capillary pressure and diabetes duration (Rs = -0.50, P = 0.020).(ABSTRACT TRUNCATED AT 250 WORDS)