Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Diab Vasc Dis Res. 2012 Oct;9(4):287-95. doi: 10.1177/1479164111432182. Epub 2012 Feb 29.
Microcirculatory and endothelial dysfunction are signs of cardiovascular engagement in patients with type 2 diabetes. This study tested whether glucose normalisation may reverse this.
Thirty-nine T2DM patients (age 61±7 years, 58% females) with signs of mild diastolic dysfunction were randomised to strict glucose control based on insulin (I-group; n=21) or oral agents (O-group; n=18) for four months. Skin microcirculation was studied with laser Doppler fluxmetry and endothelial function with brachial artery flow-mediated dilatation.
Glucose control improved (reduction of HbA(1c) I-group = -0.5%; O-group -0.7%; p=0.69). Microcirculation improved in the entire group (n=39) determined by foot laser Doppler fluxmetry (32.2±13.6 vs. 35.3±13.1 perfusion units; p<0.001) and laser Doppler fluxmetry following heating (68.8±34.0 vs. 69.3±25.1 PU; p=0.007). Improvement was more consistent with oral agents than insulin. Endothelial function expressed as flow-mediated dilatation decreased in the I-group (6.0±2.2 to 4.7±3.0%; p=0.037) but remained unchanged in the O-group (4.8±2.3 to 5.0±3.7%; n.s.).
Glycaemic normalisation improved skin microcirculation but not endothelial function in patients with type 2 diabetes with mild cardiovascular engagement.
微血管和内皮功能障碍是 2 型糖尿病患者心血管参与的标志。本研究测试了血糖正常化是否可以逆转这种情况。
39 名有轻度舒张功能障碍迹象的 2 型糖尿病患者（年龄 61±7 岁，58%为女性）被随机分为胰岛素（I 组；n=21）或口服药物（O 组；n=18）组，进行为期四个月的严格血糖控制。使用激光多普勒通量测量法研究皮肤微循环，使用肱动脉血流介导的扩张来研究内皮功能。
血糖控制得到改善（I 组 HbA1c 降低 0.5%；O 组降低 0.7%；p=0.69）。整个组（n=39）的足部激光多普勒通量测量值（32.2±13.6 与 35.3±13.1 灌注单位；p<0.001）和加热后激光多普勒通量测量值（68.8±34.0 与 69.3±25.1 PU；p=0.007）均有所改善。与胰岛素相比，口服药物的改善更为一致。I 组的内皮功能（以血流介导的扩张表示）下降（6.0±2.2 至 4.7±3.0%；p=0.037），而 O 组则保持不变（4.8±2.3 至 5.0±3.7%；n.s.）。
血糖正常化改善了 2 型糖尿病合并轻度心血管参与患者的皮肤微循环，但对内皮功能没有影响。
