Georgia Prevention Institute, Medical College of Georgia, Augusta University, 1120 15th Street, HS-1707, Augusta, GA, 30912, Georgia.
Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, Georgia.
Cardiovasc Diabetol. 2023 Sep 7;22(1):243. doi: 10.1186/s12933-023-01966-6.
Endogenous estrogen is cardio-protective in healthy premenopausal women. Despite this favorable action of estrogen, animal models depict a detrimental effect of estradiol on vascular function in the presence of diabetes. The present study sought to determine the role of endogenous estradiol on endothelial function in women with type 1 diabetes.
32 women with type 1 diabetes (HbA = 8.6 ± 1.7%) and 25 apparently healthy women (HbA = 5.2 ± 0.3%) participated. Flow-mediated dilation (FMD), a bioassay of nitric-oxide bioavailability and endothelial function was performed during menses (M) and the late follicular (LF) phase of the menstrual cycle to represent low and high concentrations of estrogen, respectively. In addition, a venous blood sample was collected at each visit to determine circulating concentrations of estradiol, thiobarbituric acid reactive substances (TBARS), and nitrate/nitrite (NOx), biomarkers of oxidative stress and nitric oxide, respectively. Data were collected in (1) 9 additional women with type 1 diabetes using oral hormonal birth control (HBC) (HbA = 8.3 ± 2.1%) during the placebo pill week and second active pill week, and (2) a subgroup of 9 demographically matched women with type 1 diabetes not using HBC (HbA = 8.9 ± 2.1%).
Overall, estradiol was significantly increased during the LF phase compared to M in both type 1 diabetes (Δestradiol = 75 ± 86 pg/mL) and controls (Δestradiol = 71 ± 76 pg/mL); however, an increase in TBARS was only observed in patients with type 1 diabetes (ΔTBARS = 3 ± 13 µM) compared to controls (ΔTBARS = 0 ± 4 µM). FMD was similar (p = 0.406) between groups at M. In addition, FMD increased significantly from M to the LF phase in controls (p = 0.024), whereas a decrease was observed in type 1 diabetes. FMD was greater (p = 0.015) in patients using HBC compared to those not on HBC, independent of menstrual cycle phase.
Endogenous estradiol increases oxidative stress and contributes to endothelial dysfunction in women with diabetes. Additionally, HBC use appears to be beneficial to endothelial function in type 1 diabetes.
内源性雌激素对健康的绝经前女性具有心脏保护作用。尽管雌激素有这种有利作用，但动物模型显示，在存在糖尿病的情况下，雌二醇对血管功能有不利影响。本研究旨在确定内源性雌二醇对 1 型糖尿病女性内皮功能的作用。
32 名患有 1 型糖尿病（HbA1c=8.6±1.7%）的女性和 25 名健康女性（HbA1c=5.2±0.3%）参加了研究。血流介导的扩张（FMD），一种测定一氧化氮生物利用度和内皮功能的生物测定法，在月经（M）期间和月经周期的晚期卵泡（LF）期进行，分别代表雌激素的低浓度和高浓度。此外，在每次就诊时采集静脉血样，以确定循环雌二醇、硫代巴比妥酸反应物质（TBARS）和硝酸盐/亚硝酸盐（NOx）的浓度，分别为氧化应激和一氧化氮的生物标志物。数据是在 1）9 名使用口服激素避孕药（HBC）的 1 型糖尿病女性（HbA1c=8.3±2.1%）在安慰剂丸周和第二丸活性丸周期间收集的，2）9 名未使用 HBC 的 1 型糖尿病女性（HbA1c=8.9±2.1%）的亚组中收集的。
总体而言，与 M 期相比，1 型糖尿病（Δ雌二醇=75±86 pg/ml）和对照组（Δ雌二醇=71±76 pg/ml）的 LF 期雌二醇显著增加；然而，仅在 1 型糖尿病患者中观察到 TBARS 增加（ΔTBARS=3±13 µM），而对照组中则没有（ΔTBARS=0±4 µM）。在 M 期，FMD 在组间相似（p=0.406）。此外，对照组的 FMD 从 M 期到 LF 期显著增加（p=0.024），而 1 型糖尿病患者的 FMD 则下降。在 HBC 使用者中，FMD 大于（p=0.015）未使用 HBC 的患者，与月经周期阶段无关。
内源性雌二醇增加氧化应激并导致糖尿病女性的内皮功能障碍。此外，HBC 的使用似乎对 1 型糖尿病患者的内皮功能有益。
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