Early impairment of large artery structure and function in type I diabetes mellitus.
OBJECTIVE
Diabetes mellitus is associated with an increased incidence of atherosclerosis. How early functional and structural alterations of large arteries that may preceded atherosclerosis occur in the course of this disease has, however, never been conclusively documented.


METHODS
We evaluated arterial wall distensibility in the radial artery, common carotid artery and abdominal aorta in 133 patients (aged 35.4 +/- 0.9 years, means +/- SEM) with Type I (insulin-dependent) diabetes mellitus and no macrovascular complications. Arterial distensibility was derived from continuous measurements of arterial diameter through echotracking techniques and use of either the Langewouters (radial artery) or the Reneman (carotid artery and aorta) formula. The same echotracking techniques enabled us to obtain radial artery and carotid artery wall thickness. Data were compared with those from 70 age-matched normotensive control subjects.


RESULTS
In diabetic patients arterial distensibility was consistently less (p < 0.01) than in control subjects, the reduction averaging 26%, 14% and 25% for the radial artery, carotid artery and aorta, respectively. This was accompanied by an increase (p < 0.01) in both radial and carotid artery wall thickness. The changes were more pronounced in patients with microalbuminuria, retinopathy or neuropathy or both. They were evident also in those without microvascular complications. This was the case also when subjects in whom diabetes was associated with hypertension (n = 30) were excluded from data analysis. Carotid and aortic wall abnormalities showed a relation with the duration of disease and blood pressure whereas radial artery abnormalities showed a relation with glycated haemoglobin.


CONCLUSIONS
Type I diabetes is characterised by diffuse arterial wall stiffening and thickening which progress with the severity of the disease but can clearly be seen also in the absence of any diabetic-related complication. This suggests that in diabetes stiffening and thickening are an early marker of vascular damage.
Giannattasio
C
C
Department of Internal Medicine, S. Gerardo Hospital, Monza, Italy.
Failla
M
M
Piperno
A
A
Grappiolo
A
A
Gamba
P
P
Paleari
F
F
Mancia
G
G
D000328:Adult; D001012:Aorta, Abdominal / Q000473:pathology / Q000502:physiology / Q000503:physiopathology*; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001830:Body Surface Area; D017536:Carotid Artery, Common / Q000473:pathology / Q000502:physiology / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology* / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000473:pathology / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D009131:Muscle, Smooth, Vascular / Q000473:pathology / Q000502:physiology / Q000503:physiopathology; D017534:Radial Artery / Q000473:pathology / Q000502:physiology / Q000503:physiopathology*; D012016:Reference Values; D013599:Systole
D001786:Blood Glucose