Decreased vascular endothelial growth factor response to acute hypoglycemia in type 2 diabetic patients with hypoglycemic coma.
BACKGROUND
Plasma vascular endothelial growth factor (VEGF) was shown to increase during acute hypoglycemia and could mediate rapid adaptation of the brain. In this study we examined the neuroendocrine response in patients with type 2 diabetes mellitus (T2DM) in hypoglycemic coma or with acute neuroglycopenic symptoms.


METHODS
We prospectively studied 135 consecutive T2DM patients admitted for severe hypoglycemia during a 2-year period. We collected clinical variables and measured plasma concentrations of VEGF, epinephrine, norepinephrine, cortisol and growth hormone at admission and 30min afterwards.


RESULTS
Thirty two patients developed hypoglycemic coma and 103 did not lose consciousness. Median plasma VEGF level of coma patients was 3.1-fold lower at baseline than that of non-coma patients, and even 5.3-fold lower 30min afterwards. Plasma epinephrine concentration was significantly lower just at baseline in coma patients. On the contrary, there were no differences in concentrations of the other hormones. Multivariate logistic regression analysis showed that VEGF concentration (OR 0.68; CI 0.51-0.95) was a protective factor against the development of coma.


CONCLUSIONS
VEGF and epinephrine responses to acute hypoglycemia are reduced in T2DM patients who develop hypoglycemic coma. An increased plasma VEGF concentration appeared to be a protective factor against the development of hypoglycemic coma.
Emergency Medicine Service, Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain. farnalich.hulp@salud.madrid.org
Francisco
F
Arnalich
Maria Constanza
MC
Maldifassi
Gema
G
Atienza
Enrique
E
Ciria
Angustias
A
Quesada
José Luis
JL
Cedillo
Jaime
J
Renart
Rosa
R
Codoceo
Rafael
R
Herruzo
Carmen
C
Montiel
D000368:Aged; D015331:Cohort Studies; D003128:Coma / Q000097:blood* / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000150:complications*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A