National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
Monash School of Medicine, Monash University, Melbourne, VIC, Australia.
Diab Vasc Dis Res. 2023 May-Jun;20(3):14791641231183634. doi: 10.1177/14791641231183634.
Peripheral arterial tonometry (PAT) provides non-invasive measures of vascular health. Beneficial effects of metformin on vascular function have been reported in youth with type 1 diabetes (T1D). In the REducing with MetfOrmin Vascular Adverse Lesions (REMOVAL) trial in adults with T1D and high cardiovascular risk, we examined: (i) the extent to which routinely-measured cardiometabolic risk factors explain variance in baseline PAT; and (ii) the effects of metformin on PAT measures.
Cross-sectional univariable and multivariable analyses of baseline reactive hyperaemia index (RHI) and augmentation index (AI) (EndoPAT® (Itamar, Israel); and analysis of 36-months metformin versus placebo on vascular tonometry.
In 364 adults ((mean ± SD) age 55.2 ± 8.5 years, T1D 34.0 ± 10.6 years, HbA1c 64.5 ± 9.0 mmol/mol (8.1 ± 0.8%)), RHI was 2.26 ± 0.74 and AI was 15.9 ± 19.2%. In an exhaustive search, independent associates of (i) RHI were smoking, waist circumference, systolic blood pressure and vitamin B12 (adjusted = 0.11) and (ii) AI were male sex, pulse pressure, heart rate and waist circumference (adjusted = 0.31). Metformin did not significantly affect RHI or AI.
Cardiometabolic risk factors explained only a modest proportion of variance in PAT measures of vascular health in adults with T1D and high cardiovascular risk. PAT measures were not affected by metformin.
外周动脉张力测量（PAT）提供了血管健康的非侵入性测量方法。已有研究报道，二甲双胍对 1 型糖尿病（T1D）青少年的血管功能有益。在有高心血管风险的 1 型糖尿病成人中进行的降低血管不良病变用二甲双胍（REMOVAL）试验中，我们研究了：（i）常规测量的心血管代谢危险因素在多大程度上解释了基线 PAT 的差异；（ii）二甲双胍对 PAT 测量的影响。
对基线反应性充血指数（RHI）和增强指数（AI）（EndoPAT®（以色列 Itamar））进行横断面单变量和多变量分析；并分析了 36 个月的二甲双胍与安慰剂对血管张力测量的影响。
在 364 名成年人（（平均 ± 标准差）年龄 55.2 ± 8.5 岁，T1D 34.0 ± 10.6 岁，HbA1c 64.5 ± 9.0 mmol/mol（8.1 ± 0.8%））中，RHI 为 2.26 ± 0.74，AI 为 15.9 ± 19.2%。在详尽的搜索中，（i）RHI 的独立相关因素为吸烟、腰围、收缩压和维生素 B12（调整后的 = 0.11）和（ii）AI 的独立相关因素为性别、脉压、心率和腰围（调整后的 = 0.31）。二甲双胍对 RHI 或 AI 没有显著影响。
在有高心血管风险的 T1D 成人中，心血管代谢危险因素仅能解释 PAT 血管健康测量结果的一小部分差异。PAT 测量结果不受二甲双胍影响。
