Key result
During the early course of type 2 diabetes, flow-mediated dilation decreased by 13.9% over 5 years (P=0.013), with baseline insulin sensitivity predicting progressive endothelial impairment.
Why the study?
Endothelial dysfunction may occur early in cardiovascular and metabolic diseases but is often underestimated, and studies rarely discriminate between diabetes types.
Cohort (n=507)
Endothelial function progressively declines during the early course of type 2 diabetes, with baseline insulin sensitivity serving as a strong predictor of this impairment.
Answers are grounded in this paper and cite their sources.
Endothelial monitoring may warrant consideration early in type 2 diabetes; leaves open whether improving insulin sensitivity alters progression.
CONTEXT: Endothelial dysfunction may occur early in the development of cardiovascular and metabolic diseases; however, it remains often underestimated and studies rarely discriminate between diabetes types. We have examined endothelial function and its determinants during the early course of type 1 and type 2 diabetes. METHODS: Caucasian participants of the prospective German Diabetes Study (GDS) with known diabetes duration <1 year (n = 398) or without diabetes, but of similar age, body mass index (BMI) and sex distribution (n = 109), underwent measurements of flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD). Whole-body insulin sensitivity (M-value) was assessed by hyperinsulinemic-euglycemic clamps and physical fitness (VO2max) by spiroergometry. A subset of individuals with type 1 or type 2 diabetes (n = 108) was re-evaluated after 5 years. RESULTS: At baseline, neither FMD nor NMD differed between people with diabetes and the matched glucose-tolerant groups. At the 5-year follow-up, decline in FMD (-13.9%, P = .013) of persons with type 2 diabetes was independent of age, sex, and BMI, but associated with baseline adipose tissue insulin resistance and indices of liver fibrosis. The M-value decreased in both type 1 and type 2 diabetes groups by 24% and 15% (both P < .001, respectively) over 5 years. Higher HbA1c, lower M-value, and lower VO2max at baseline was associated with lower FMD in both type 1 and type 2 diabetes. CONCLUSION: Endothelial function decreases during the early course of type 2 diabetes. In addition to age and BMI, insulin sensitivity at diagnosis was the best predictor of progressive impairment in endothelial function in type 2 diabetes.
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Zaharia et al. (2022) conducted a cohort in Type 1 and Type 2 Diabetes (n=507). Type 1 and Type 2 Diabetes vs. Participants without diabetes was evaluated on Change in flow-mediated dilation (FMD) (p=0.013). During the early course of type 2 diabetes, flow-mediated dilation decreased by 13.9% over 5 years (P=0.013), with baseline insulin sensitivity predicting progressive endothelial impairment.
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