title: Strict glycaemic control improves skin microcirculation in patients with type 2 diabetes: a report from the Diabetes mellitus And Diastolic Dysfunction (DADD) study.
abstract: BACKGROUND
  Microcirculatory and endothelial dysfunction are signs of cardiovascular engagement in patients with type 2 diabetes. This study tested whether glucose normalisation may reverse this.
  
  
  METHODS
  Thirty-nine T2DM patients (age 61±7 years, 58% females) with signs of mild diastolic dysfunction were randomised to strict glucose control based on insulin (I-group; n=21) or oral agents (O-group; n=18) for four months. Skin microcirculation was studied with laser Doppler fluxmetry and endothelial function with brachial artery flow-mediated dilatation.
  
  
  RESULTS
  Glucose control improved (reduction of HbA(1c) I-group = -0.5%; O-group -0.7%; p=0.69). Microcirculation improved in the entire group (n=39) determined by foot laser Doppler fluxmetry (32.2±13.6 vs. 35.3±13.1 perfusion units; p<0.001) and laser Doppler fluxmetry following heating (68.8±34.0 vs. 69.3±25.1 PU; p=0.007). Improvement was more consistent with oral agents than insulin. Endothelial function expressed as flow-mediated dilatation decreased in the I-group (6.0±2.2 to 4.7±3.0%; p=0.037) but remained unchanged in the O-group (4.8±2.3 to 5.0±3.7%; n.s.).
  
  
  CONCLUSIONS
  Glycaemic normalisation improved skin microcirculation but not endothelial function in patients with type 2 diabetes with mild cardiovascular engagement.
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. christina.jarnert@karolinska.se
authors.forename: Christina
authors.initials: C
authors.lastname: Jarnert
authors.forename: Majid
authors.initials: M
authors.lastname: Kalani
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.forename: Felix
authors.initials: F
authors.lastname: Böhm
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D001916:Brachial Artery / Q000187:drug effects / Q000503:physiopathology; D002219:Carbamates / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D003971:Diastole; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D061267:Insulin Aspart / Q000627:therapeutic use; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000627:therapeutic use; D017078:Laser-Doppler Flowmetry; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D012867:Skin / Q000098:blood supply*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects; D018754:Ventricular Dysfunction / Q000209:etiology / Q000503:physiopathology*; D016276:Ventricular Function
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002219:Carbamates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061267:Insulin Aspart; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008687:Metformin; D010880:Piperidines; C517652:hemoglobin A1c protein, human; C072379:repaglinide