title: Diabetic retinopathy is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients.
abstract: Diabetic retinopathy (DR) and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients without insulin treatment. Seventy persons were diagnosed to have type 2 diabetes in the examination from June 2004 to May 2006. The study group consisted of 29 type 2 diabetic patients with DR (age: 58+/-6 years, mean+/-s.d.) and 41 type 2 diabetic patients with no DR (NDR) (n=41, 58+/-5 years). Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability, plasma norepinephrine concentration and cardiac (123)I-metaiodobenzylguanidine (MIBG) scintigraphic findings. DR patients had lower BRS, early and delayed (123)I-MIBG myocardial uptake values and higher percent washout rate (WR) of (123)I-MIBG than the NDR patients. With respect to metabolic findings, DR patients had higher fasting plasma insulin concentration (P<0.0001) and higher homeostasis model assessment (HOMA) index (P<0.00001) than the NDR patients. Multiple logistic regression analysis revealed that the presence of DR was independently predicted by HOMA index and the percent WR of (123)I-MIBG (P<0.01 and P<0.05, respectively). Our results suggest that DR is associated with depressed cardiovascular autonomic function and insulin resistance and that HOMA index and the percent WR of (123)I-MIBG are independently associated with DR in Japanese patients with type 2 diabetes mellitus.
authors.affiliation: Department of Cardiology, Oita Red Cross Hospital, Oita, Japan. anan-f@med.oita-u.ac.jp
authors.forename: Futoshi
authors.initials: F
authors.lastname: Anan
authors.forename: Masaki
authors.initials: M
authors.lastname: Takayuki
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
authors.forename: Mikiko
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Eshima
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Saikawa
authors.forename: Hironobu
authors.initials: H
authors.lastname: Yoshimatsu
mesh_terms: D019797:3-Iodobenzylguanidine; D000886:Anthropometry; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000150:complications / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007333:Insulin Resistance / Q000502:physiology*; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011877:Radionuclide Imaging
chemical_list: D019797:3-Iodobenzylguanidine; D009638:Norepinephrine