title: Uncomplicated human type 2 diabetes is associated with meal-induced blood pressure lowering and cardiac output increase.
abstract: OBJECTIVE
  Since many type 2 diabetes patients experience postprandial hypotension, the aim of this study was to unravel meal-related changes in systemic hemodynamics and autonomic nervous system (ANS)-balance.
  
  
  METHODS
  Forty-two age-matched males (15 type 2 diabetes; 12 metabolic syndrome; 15 controls) without overt autonomic neuropathy received a standardized high-fat mixed meal after an overnight fast. Hemodynamic variables were measured by finger plethysmography. Fourier analysis was used to calculate the low-/high-frequency (LF/HF)-ratio, a marker of autonomic nervous system-balance, and baroreceptor reflex sensitivity (BRS).
  
  
  RESULTS
  Following the meal, diastolic blood pressure (DBP) decreased in type 2 diabetes patients only, paralleled by a significant decrement in systemic vascular resistance (SVR) and an increase in cardiac index. All groups showed an increase in postprandial heart rate. Controls, but not metabolic syndrome or type 2 diabetes patients, showed a meal-related increase in LF/HF-ratio. When combining all study subjects, homeostatic model assessment-insulin resistance (HOMA-IR) was inversely correlated with changes in DBP, SVR, LF/HF-ratio and BRS.
  
  
  CONCLUSIONS
  Based on these data, we hypothesize that in patients with uncomplicated type 2 diabetes, insulin resistance hampers adequate meal-induced sympathetic activation, leading to a decrease in SVR and resulting in a postprandial drop in DBP.
authors.affiliation: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: mm.smits1@vumc.nl.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Smits
authors.affiliation: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcel H A
authors.initials: MH
authors.lastname: Muskiet
authors.affiliation: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Maarten E
authors.initials: ME
authors.lastname: Tushuizen
authors.affiliation: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Kelly A A
authors.initials: KA
authors.lastname: Kwa
authors.affiliation: Department of Systems Physiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: John M
authors.initials: JM
authors.lastname: Karemaker
authors.affiliation: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Daniël H
authors.initials: DH
authors.lastname: van Raalte
authors.affiliation: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Michaela
authors.initials: M
authors.lastname: Diamant
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology*
keywords: Autonomic nervous system; Metabolic syndrome; Postprandial hemodynamics; Type 2 diabetes