Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
J Diabetes Investig. 2022 Apr;13(4):677-686. doi: 10.1111/jdi.13705. Epub 2021 Nov 29.
AIMS/INTRODUCTION: Diabetes mellitus is associated with endothelial dysfunction. However, it is still controversial as to whether antidiabetic drug treatment affects endothelial function. The purpose of this study was to evaluate the relationships of the hemoglobin A1c (HbA1c) level with flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID) in patients with type 2 diabetes mellitus who are receiving antidiabetic drugs.
The FMD was measured in 866 patients with type 2 diabetes mellitus who were receiving antidiabetic drugs (625 men and 241 women; mean age: 62 ± 10 years). The patients were divided into four groups according to HbA1c levels: <6.5, 6.5-6.9, 7.0-7.9, and ≥8.0%.
There was an inverted U-shaped pattern of association of the HbA1c level with the FMD at an HbA1c level of about 7% of the peak of FMD in patients with type 2 diabetes mellitus who were receiving antidiabetic drugs. The FMD was significantly smaller in the HbA1c <6.5% group than in the HbA1c 6.5-6.9% group and the HbA1c 7.0-7.9% group (P < 0.001 and P < 0.001, respectively). The FMD values were similar in the HbA1c <6.5% group and HbA1c ≥8.0% group (P = 0.10). There were no significant differences in NID among the four groups (P = 0.98).
These findings suggest that a low HbA1c <6.5% as well as a high HbA1c ≥8.0% is associated with endothelial dysfunction in patients with type 2 diabetes mellitus who are receiving antidiabetic drugs and that vascular smooth muscle function is similar in such patients regardless of the HbA1c level.
目的/引言：糖尿病与血管内皮功能障碍有关。然而，抗糖尿病药物治疗是否影响内皮功能仍存在争议。本研究旨在评估接受抗糖尿病药物治疗的 2 型糖尿病患者的糖化血红蛋白（HbA1c）水平与血流介导的血管舒张（FMD）和硝酸甘油诱导的血管舒张（NID）的关系。
在接受抗糖尿病药物治疗的 866 例 2 型糖尿病患者（625 名男性和 241 名女性；平均年龄：62±10 岁）中测量 FMD。根据 HbA1c 水平将患者分为四组：<6.5、6.5-6.9、7.0-7.9 和≥8.0%。
在接受抗糖尿病药物治疗的 2 型糖尿病患者中，HbA1c 水平与 FMD 呈倒 U 型关系，在 HbA1c 约为 FMD 峰值的 7%时达到峰值。HbA1c<6.5%组的 FMD 明显小于 HbA1c 6.5-6.9%组和 HbA1c 7.0-7.9%组（P<0.001 和 P<0.001）。HbA1c<6.5%组和 HbA1c≥8.0%组的 FMD 值相似（P=0.10）。四组之间的 NID 无显著差异（P=0.98）。
这些发现表明，接受抗糖尿病药物治疗的 2 型糖尿病患者中，HbA1c<6.5%和 HbA1c≥8.0%均与内皮功能障碍有关，无论 HbA1c 水平如何，血管平滑肌功能在这些患者中均相似。
