Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK.
Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK.
Cardiovasc Diabetol. 2017 Sep 15;16(1):114. doi: 10.1186/s12933-017-0594-7.
Good glycaemic control in type 2 diabetes (T2DM) protects the microcirculation. Current guidelines suggest glycaemic targets be relaxed in advanced diabetes. We explored whether disease duration or pre-existing macrovascular complications attenuated the association between hyperglycaemia and microvascular function.
743 participants with T2DM (n = 222), cardiovascular disease (CVD = 183), both (n = 177) or neither (controls = 161) from two centres in the UK, underwent standard clinical measures and endothelial dependent (ACh) and independent (SNP) microvascular function assessment using laser Doppler imaging.
People with T2DM and CVD had attenuated ACh and SNP responses compared to controls. This was additive in those with both (ANOVA p < 0.001). In regression models, cardiovascular risk factors accounted for attenuated ACh and SNP responses in CVD, whereas HbAc accounted for the effects of T2DM. HbAc was associated with ACh and SNP response after adjustment for cardiovascular risk factors (adjusted standardised beta (β) -0.096, p = <0.008 and -0.135, p < 0.001, respectively). Pre-existing CVD did not modify this association (β -0.099; p = 0.006 and -0.138; p < 0.001, respectively). Duration of diabetes accounted for the association between HbAc and ACh (β -0.043; p = 0.3), but not between HbAc and SNP (β -0.105; p = 0.02).
In those with T2DM and CVD, good glycaemic control is still associated with better microvascular function, whereas in those with prolonged disease this association is lost. This suggests duration of diabetes may be a better surrogate for "advanced disease" than concomitant CVD, although this requires prospective validation.
2 型糖尿病（T2DM）患者血糖控制良好可保护其微循环。目前的指南建议放宽对糖尿病晚期患者的血糖目标。我们探讨了疾病持续时间或预先存在的大血管并发症是否会减弱高血糖与微血管功能之间的关联。
来自英国两个中心的 743 名 T2DM 患者（n=222）、心血管疾病患者（CVD=183）、同时患有两种疾病的患者（n=177）或既无 T2DM 也无 CVD 的患者（对照组，n=161）接受了标准的临床测量和激光多普勒成像评估内皮依赖性（ACh）和非依赖性（SNP）微血管功能。
与对照组相比，同时患有 T2DM 和 CVD 的患者其 ACh 和 SNP 反应减弱。在同时患有两种疾病的患者中，这种情况更为明显（方差分析 p<0.001）。在回归模型中，心血管危险因素解释了 CVD 患者 ACh 和 SNP 反应减弱的原因，而 HbAc 则解释了 T2DM 患者的影响。在调整心血管危险因素后，HbAc 与 ACh 和 SNP 反应相关（调整后的标准化β值分别为-0.096，p<0.008 和-0.135，p<0.001）。预先存在的 CVD 并没有改变这种关联（β值分别为-0.099；p=0.006 和-0.138；p<0.001）。糖尿病病程解释了 HbAc 与 ACh 之间的关系（β值为-0.043；p=0.3），但与 HbAc 和 SNP 之间的关系无关（β值为-0.105；p=0.02）。
在同时患有 T2DM 和 CVD 的患者中，良好的血糖控制仍与更好的微血管功能相关，而在病程较长的患者中，这种关联则消失。这表明，与同时存在的 CVD 相比，糖尿病病程可能是“晚期疾病”的更好替代指标，尽管这需要前瞻性验证。
Zotero 插件
