Department of Health Science, University Magna Graecia, Catanzaro, Italy.
University Magna Graecia, School of Medicine, Catanzaro, Italy.
PLoS One. 2019 Mar 5;14(3):e0212871. doi: 10.1371/journal.pone.0212871. eCollection 2019.
Intensive treatment aimed at achieving optimal metabolic control to prevent the development of chronic diabetic complications is often associated with an increased rate of hypoglycemic events. Hypoglycemia is believed to be responsible for acute fatal and nonfatal cardiovascular events likely as a consequence of the activation of pro-inflammatory and pro-atherothrombotic pathways. Hypoglycemia has been reported to influence the development of preclinical atherosclerosis. The present study was designed to prospectively evaluate whether hypoglycemia influences the function and the morphology of the arteries in subjects with type 2 diabetes without complications and uncontrolled diabetes.
Seventy-six subjects underwent a noninvasive evaluation of carotid wall thickness and brachial artery function at baseline and after one year of treatment with the intent of obtaining optimal glycemic control. At the end of the observation time, subjects were divided in two groups: with hypoglycemia (H-group) or without hypoglycemia (C-group).
Baseline characteristic were comparable between groups. HbA1c significantly decreased in both groups, and fasting plasma glucose was only significant in the H-group. Subjects with hypoglycemia showed a significant reduction of carotid wall thickness after one-year of treatment (H-groups: right baseline 834±141 vs. 1-year 770±132 μ p<0.05; C-group: 757±162 vs. 767±135 μ p = ns). Endothelial function remained unchanged during the study for both groups.
The present findings demonstrate that hypoglycemia does not affect endothelial function. Furthermore, subjects who experience more hypoglycemia show significant reduction of carotid wall thickness. Optimal metabolic control should be pursued as soon as possible.
旨在实现最佳代谢控制以预防慢性糖尿病并发症的强化治疗常伴有低血糖事件发生率增加。低血糖被认为是导致急性致命和非致命心血管事件的原因，可能是由于促炎和促动脉血栓形成途径的激活。低血糖已被报道会影响临床前动脉粥样硬化的发展。本研究旨在前瞻性评估低血糖是否会影响无并发症和未控制糖尿病的 2 型糖尿病患者的动脉功能和形态。
76 名患者在基线时和治疗 1 年后接受了颈动脉壁厚度和肱动脉功能的非侵入性评估，目的是获得最佳血糖控制。在观察结束时，将患者分为两组：有低血糖（H 组）或无低血糖（C 组）。
两组的基线特征无差异。两组的 HbA1c 均显著降低，空腹血糖仅在 H 组显著降低。低血糖组在治疗 1 年后颈动脉壁厚度显著降低（H 组：右侧基线 834±141 与 1 年时 770±132 μ p<0.05；C 组：757±162 与 767±135 μ p = ns）。两组内皮功能在研究期间均无变化。
本研究结果表明，低血糖不会影响内皮功能。此外，经历更多低血糖的患者颈动脉壁厚度显著降低。应尽快追求最佳代谢控制。
