Higher arterial stiffness, greater peripheral vascular resistance and lower blood flow in lower‐leg arteries are associated with long‐term hyperglycaemia in type 2 diabetic patients with normal ankle‐brachial index
- 30 March 2009
- journal article
- research article
- Published by Wiley in Diabetes/Metabolism Research and Reviews
- Vol. 25 (4), 363-369
- https://doi.org/10.1002/dmrr.955
Abstract
Background Higher arterial stiffness and greater peripheral vascular resistance reduce blood flow in lower‐leg arteries and contribute to the development of ischaemic limb in diabetic patients even without peripheral artery occlusive disease. The aim of this study was to clarify whether these vascular parameters are associated with long‐term hyperglycaemia in diabetic patients. Methods We examined 45 type 2 diabetic patients and 38 age‐matched nondiabetic subjects without peripheral artery occlusive disease assessed by ankle‐brachial index consecutively admitted to our hospital, and followed them over a 3‐year period (3.7 ± 0.7 years) with no vasodilative medication. Blood flow and resistive index, a measure of peripheral vascular resistance, at the popliteal artery were evaluated using gated two‐dimensional cine‐mode phase‐contrast magnetic resonance imaging. Brachial‐ankle pulse wave velocity was measured to assess arterial stiffness. Results At baseline, consistent with our previous report, diabetic patients showed higher brachial‐ankle pulse wave velocity (p < 0.0001) and resistive index (p < 0.0001) and lower flow volume (p = 0.0044) than those of nondiabetic subjects. Stepwise multiple regression analysis revealed that duration of diabetes, mean HbA1c during the study, use of renin‐angiotensin system inhibitors and change per year in resistive index were identified as significant independent variables predicting change per year in blood flow (r2 = 0.733, p < 0.0001) in diabetic patients. Mean HbA1c during the study was positively correlated with changes per year in brachial‐ankle pulse wave velocity (p = 0.00007) and resistive index (p = 0.0014) and was negatively correlated with that in blood flow (p < 0.0001) in diabetic patients. Conclusions Long‐term hyperglycaemia is a major cause of impaired peripheral circulation in lower‐leg arteries in diabetic patients without peripheral artery occlusive disease. Copyright © 2009 John Wiley & Sons, Ltd.Keywords
This publication has 30 references indexed in Scilit:
- Standards of Medical Care in Diabetes—2008Diabetes Care, 2008
- Peripheral Arterial Disease in People With DiabetesDiabetes Care, 2003
- Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes MellitusNew England Journal of Medicine, 2003
- Arterial Stiffness Increases With Deteriorating Glucose Tolerance StatusCirculation, 2003
- Progression of large artery structural and functional alterations in Type I diabetesDiabetologia, 2001
- Medial Artery CalcificationArteriosclerosis, Thrombosis, and Vascular Biology, 1996
- Impaired nitric oxide-mediated vasodilation in patients with non-insulin-dependent diabetes mellitusJournal of the American College of Cardiology, 1996
- Nitric oxide release accounts for insulin's vascular effects in humans.JCI Insight, 1994
- Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjectsDiabetologia, 1993
- Diminished arterial elasticity in diabetes: association with fluorescent advanced glycosylation end products in collagenCardiovascular Research, 1993