Noninvasive detection of functional alterations of the arterial wall in IDDM patients with and without microalbuminuria.
OBJECTIVE
To test endothelial function in a group of 10 normoalbuminuric and eight microalbuminuric insulin-dependent diabetes mellitus patients (ages 28 +/- 3 [mean +/- SE] and 28 +/- 1 years, respectively), in comparison with 16 control subjects (age 35 +/- 2 years, normal subjects vs. diabetic subjects P = NS), to identify prestructural abnormalities of the arterial wall. An early stage of vascular involvement seems in fact to be characterized by functional alterations of endothelial control on vascular tone and wall interaction with circulating cells. Furthermore, many recent studies suggest the importance of microalbuminuria as an early marker not only of nephropathy but also of retinopathy and macroangiopathy.


METHODS
Endothelium-mediated flow-dependent vasodilation and endothelium-independent vasodilation (induced by glyceryl trinitrate administration) were evaluated in the right common femoral artery by echo-Doppler ultrasound. Arterial wall distensibility was evaluated at the common femoral artery by an echo-tracking system.


RESULTS
In spite of a comparable increase in flow velocity, endothelium-mediated vasodilation was significantly reduced in diabetic subjects, particularly in microalbuminuric patients. Endothelium-independent vasodilation was also significantly impaired in diabetic subjects, particularly in microalbuminuric subjects; whereas arterial wall distensibility, an index of the viscoelastic properties of the wall, was similar in the three groups.


CONCLUSIONS
These results confirm a reduced vasodilatory capacity in diabetes mellitus, with a more marked alteration in microalbuminuric diabetic subjects. This reliable, noninvasive evaluation of arterial function is particularly useful for early diagnosis of vascular involvement.
Zenere
B M
BM
Department of Metabolic Diseases, University of Verona, Italy.
Arcaro
G
G
Saggiani
F
F
Rossi
L
L
Muggeo
M
M
Lechi
A
A
D000328:Adult; D000419:Albuminuria; D001794:Blood Pressure; D002339:Carotid Arteries / Q000502:physiology / Q000503:physiopathology*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000473:pathology / Q000502:physiology / Q000503:physiopathology*; D005263:Femoral Artery / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology*; D019270:Fructosamine; D006442:Glycated Hemoglobin / Q000032:analysis; D006339:Heart Rate; D006595:Hexosamines / Q000097:blood; D006801:Humans; D005996:Nitroglycerin / Q000494:pharmacology; D012016:Reference Values; D012044:Regression Analysis; D014280:Triglycerides / Q000097:blood; D014664:Vasodilation; D014665:Vasodilator Agents / Q000494:pharmacology
D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019270:Fructosamine; D006442:Glycated Hemoglobin; D006595:Hexosamines; D005996:Nitroglycerin; D014280:Triglycerides; D014665:Vasodilator Agents