Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
Diabetes. 2020 May;69(5):1011-1019. doi: 10.2337/db19-0990. Epub 2020 Feb 21.
Impaired baroreflex sensitivity (BRS) predicts cardiovascular mortality and is prevalent in long-term diabetes. We determined spontaneous BRS in patients with recent-onset diabetes and its temporal sequence over 5 years by recording beat-to-beat blood pressure and R-R intervals over 10 min. Four time domain and four frequency domain BRS indices were computed in participants from the German Diabetes Study baseline cohort with recent-onset type 1/type 2 diabetes ( = 206/381) and age-matched glucose-tolerant control subjects (control 1/control 2: = 65/83) and subsets of consecutive participants with type 1/type 2 diabetes who reached the 5-year follow-up ( = 84/137). Insulin sensitivity (M-value) was determined using a hyperinsulinemic-euglycemic clamp. After appropriate adjustment, three frequency domain BRS indices were reduced in type 2 diabetes compared with control 2 and were positively associated with the M-value and inversely associated with fasting glucose and HbA ( < 0.05), whereas BRS was preserved in type 1 diabetes. After 5 years, a decrease in one and four BRS indices was observed in patients with type 1 and type 2 diabetes, respectively ( < 0.05), which was explained by the physiologic age-dependent decline. Unlike patients with well-controlled recent-onset type 1 diabetes, those with type 2 diabetes show early baroreflex dysfunction, likely due to insulin resistance and hyperglycemia, albeit without progression over 5 years.
自主神经血压调节功能受损（BRS）可预测心血管死亡率，并且在长期糖尿病中较为常见。我们通过记录 10 分钟的血压和 R-R 间期，确定了近期发病的糖尿病患者的自主 BRS 及其在 5 年内的时间序列。在德国糖尿病研究的基线队列中，有近期发病的 1 型/2 型糖尿病患者（=206/381）和年龄匹配的糖耐量正常对照者（对照 1/对照 2：=65/83），以及连续的 1 型/2 型糖尿病患者亚组（=84/137）进行了 4 个时域和 4 个频域 BRS 指数的计算，这些患者达到了 5 年的随访。使用高胰岛素正葡萄糖钳夹法测定胰岛素敏感性（M 值）。经过适当调整，与对照 2 相比，2 型糖尿病患者的 3 个频域 BRS 指数降低，与 M 值呈正相关，与空腹血糖和 HbA 呈负相关（<0.05），而 1 型糖尿病的 BRS 则保持不变。5 年后，1 型和 2 型糖尿病患者分别观察到一个和四个 BRS 指数下降（<0.05），这与生理年龄相关的下降有关。与血糖控制良好的近期发病 1 型糖尿病患者不同，2 型糖尿病患者表现出早期的压力反射功能障碍，可能与胰岛素抵抗和高血糖有关，但在 5 年内没有进展。
