Microvascular dysfunction evident in prediabetes
medwireNews: Analysis of the Maastricht study reveals microvascular dysfunction in the eyes and skin of people with prediabetes.
The findings extend the “ticking clock hypothesis” to prediabetes, confirming that vascular dysfunction is detectable well before the diagnosis of Type 2 diabetes, say Coen Stehouwer (Maastricht University Medical Center, the Netherlands) and co-researchers.
The team assessed the study participants’ retinas and skin “as these are unique sites enabling direct and reproducible assessment of microvascular function”.
They found that average flicker light-induced retinal arteriolar dilation was 3.4% among 1269 participants with normal blood glucose levels, but was reduced to 3.0% in 335 with prediabetes and still further, to 2.3%, in 609 participants with Type 2 diabetes. All three groups had similar baseline arteriolar diameters.
The differences in retinal microvascular function were significant after accounting for variables including age, gender, body mass index, lipid levels, medication use, cardiovascular disease and retinopathy.
Likewise, despite no between-group differences in baseline skin blood flow, the heat-induced hyperaemic response was an average of 1234.9% in normoglycaemic participants, compared with 1108.7% in those with prediabetes and 936.7% in those with diabetes. Again, the differences were significant after accounting for confounders – although attenuated, the association between glycaemic status and microvascular dysfunction remained significant.
Both microvascular endpoints were associated with levels of glycated haemoglobin and fasting plasma glucose, and skin hyperaemic response was also associated with 2-hour post-load glucose levels, the researchers note in Circulation.
“Taken together, these data support the concept that generalized microvascular dysfunction occurs prior to the diagnosis of [Type 2 diabetes] and may play a role in disorders that are (in part) of microvascular origin and that may occur early in the course of [Type 2 diabetes] and indeed in prediabetes, notably retinopathy, nephropathy, neuropathy, heart failure, stroke, and cognitive decline”, they write.
The team concludes: “These findings suggest that both early hyperglycemia and microvascular dysfunction should be considered as potential targets of intervention.”
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