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Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study

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Abstract

Circulating endothelial progenitor cells (EPCs) are involved in the repairing mechanisms of vascular damage. Glucose variability may contribute to the development of chronic vascular complications of diabetes. We evaluated whether reducing glucose variability with continuous subcutaneous insulin infusion (CSII) would increase circulating levels of EPCs in type 1 diabetes. The study population consisted of 106 type 1 diabetic patients: 41 subjects considered eligible for CSII completed a 6-month follow-up. Sixty-five patients on intensified insulin therapy with multiple daily injections served as control group. Seven EPCs phenotypes were assessed by flow cytometry, and glucose variability by mean amplitude of glycemic excursions (MAGE). Both CD34+KDR+ [difference between groups 32.0, 95 % CI (19.6–44.4) number/106 cells, P < 0.001] and CD34+KDR+CD133+ [12.5 (5.5–19.5), P < 0.001)] cell count increased at endpoint in the CSII group, associated with a reduction of MAGE [−1.1 (−2.1 to −0.1), P = 0.026]. No changes occurred in the control group. In multivariate analyses, changes in MAGE were independently associated with changes in both CD34+KDR+ (P = 0.019) and CD34+KDR+CD133+ (P = 0.022) cell count. Reducing glucose variability with CSII in type 1 diabetes increases circulating EPCs levels, suggesting a novel mechanism of vascular damage by oscillating glucose.

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Author information

Authors and Affiliations

  1. Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Aging, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy

    Maria Ida Maiorino, Ofelia Casciano, Elisabetta Della Volpe, Giuseppe Bellastella & Dario Giugliano

  2. Department of Clinical and Experimental Medicine, Second University of Naples, via Pansini n° 5, 80131, Naples, Italy

    Katherine Esposito

Authors
  1. Maria Ida Maiorino
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  2. Ofelia Casciano
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  3. Elisabetta Della Volpe
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  4. Giuseppe Bellastella
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  5. Dario Giugliano
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  6. Katherine Esposito
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Corresponding author

Correspondence to Maria Ida Maiorino.

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Additional information

The METRO Study Group members are listed in Appendix.

Appendix

Appendix

The Management and Technology for Transition (METRO) Study Group

Medical expertise

Filomena Castaldo, MD, Diabetes Center at Second University of Naples, Naples, Italy.

Maria Rosaria Improta, MD, PhD, Diabetes Center at Second University of Naples, Naples, Italy.

Michela Petrizzo, MD; IOS and Coleman – Medicina Futura Medical Center, Centro Direzionale, Naples, Italy.

Nursing assistance

Concetta Verazzo, Diabetes Center at Second University of Naples, Naples, Italy.

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Maiorino, M.I., Casciano, O., Volpe, E.D. et al. Reducing glucose variability with continuous subcutaneous insulin infusion increases endothelial progenitor cells in type 1 diabetes: an observational study. Endocrine 52, 244–252 (2016). https://doi.org/10.1007/s12020-015-0686-7

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  • DOI: https://doi.org/10.1007/s12020-015-0686-7

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