Lindenberger Marcus, Lindström Torbjörn, Länne Toste
Corresponding author: Marcus Lindenberger,
Diabetes Care. 2013 Dec;36(12):4076-82. doi: 10.2337/dc13-0468. Epub 2013 Oct 15.
Diabetes is associated with hemodynamic instability during different situations involving acute circulatory stress in daily life. Young men with type 1 diabetes have been shown to have impaired circulatory response to hypovolemic stress. The effect of type 1 diabetes on cardiovascular response to hypovolemia in young women is unknown, however.
Lower body negative pressure of 30 cm H2O was used to create rapid hypovolemic stress in 15 young women with type 1 diabetes (DW) and 16 healthy women (control subjects [C]). Compensatory mobilization of venous capacitance blood (capacitance response) and net fluid absorption from tissue to blood were measured with a volumetric technique. Overall cardiovascular responses and plasma norepinephrine levels were measured.
Capacitance response was reduced (DW, 0.67 ± 0.05; C, 0.92 ± 0.06) and developed slower in DW (P < 0.01). Capacitance response was further reduced with increasing levels of HbA1c. Fluid absorption was almost halved in DW (P < 0.01). The initial vasoconstrictor response was reduced and developed slower in DW (P < 0.05). Arterial vasoconstriction was further reduced in the presence of microvascular complications (P < 0.05).
DW present with decreased and slower mobilization of venous capacitance blood and decreased net fluid absorption from tissue to blood during hypovolemic circulatory stress. Collectively, this indicates that DW are prone to hemodynamic instability, especially in the presence of microvascular complications and poor glycemic control.
糖尿病与日常生活中涉及急性循环应激的不同情况下的血流动力学不稳定有关。已证明患有1型糖尿病的年轻男性对低血容量应激的循环反应受损。然而，1型糖尿病对年轻女性低血容量时心血管反应的影响尚不清楚。
使用30 cm H2O的下体负压在15名1型糖尿病年轻女性（糖尿病组[DW]）和16名健康女性（对照组[C]）中产生快速低血容量应激。采用容积技术测量静脉容量血液的代偿性动员（容量反应）和从组织到血液的净液体吸收。测量总体心血管反应和血浆去甲肾上腺素水平。
糖尿病组的容量反应降低（糖尿病组，0.67±0.05；对照组，0.92±0.06），且发展较慢（P<0.01）。随着糖化血红蛋白水平的升高，糖尿病组的容量反应进一步降低。糖尿病组的液体吸收几乎减半（P<0.01）。糖尿病组最初的血管收缩反应降低且发展较慢（P<0.05）。在存在微血管并发症的情况下，动脉血管收缩进一步降低（P<0.05）。
在低血容量循环应激期间，糖尿病组静脉容量血液的动员减少且缓慢，从组织到血液的净液体吸收减少。总体而言，这表明糖尿病组易于出现血流动力学不稳定，尤其是在存在微血管并发症和血糖控制不佳的情况下。
