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Bane A, Wilson L, Jumper J, Spindler L, Wyatt P, Willoughby D. Effects of Blood Flow Restriction Resistance Training on Autonomic and Endothelial Function in Persons with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:761-775. [PMID: 38701159 PMCID: PMC11191514 DOI: 10.3233/jpd-230259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/05/2024]
Abstract
Background Autonomic dysfunction precedes endothelial dysfunction in Parkinson's disease (PD) and causes blood pressure and circulation abnormalities that are highly disruptive to one's quality of life. While exercise interventions have proven helpful for motor symptoms of PD, improving associated non-motor symptoms is limited. Low-intensity resistance training with blood flow restriction (LIRT-BFR) improves autonomic dysfunction in non-PD patients and high-intensity resistance training (HIRT) is recommended for motor symptom improvements for people with PD (PwPD). Objective To determine the effects of LIRT-BFR and HIRT on homocysteine and autonomic and endothelial function in PwPD and to determine the hemodynamic loads during LIRT-BFR and HIRT in PwPD using a novel exercise protocol. Methods Thirty-eight PwPD were assigned LIRT-BFR, HIRT or to a control (CNTRL) group. The LIRT-BFR and HIRT groups exercised three days per week for four weeks. The LIRT-BFR protocol used 60% limb occlusion pressure (LOP) and performed three sets of 20 repetitions at 20% of the one-repetition maximum (1RM). The HIRT group performed three sets of eight repetitions at 80% 1RM. The CNTRL group was asked to continue their normal daily routines. Results LIRT-BFR significantly improved orthostatic hypotension (p = 0.026), homocysteine levels (p < 0.001), peripheral circulation (p = 0.003), supine blood pressure (p = 0.028) and heart rate variability (p = 0.041); LIRT-BFR improved homocysteine levels (p < 0.018), peripheral circulation (p = 0.005), supine blood pressure (p = 0.007) and heart rate variability (p = 0.047) more than HIRT; and hemodynamic loads for LIRT-BFR and HIRT were similar. Conclusions LIRT-BFR may be more effective than HIRT for autonomic and endothelial function improvements in PwPD and hemodynamic loads may be lessened in LIRT-BFR protocols using single-joint exercises with intermittent blood flow restriction. Further research is needed to determine if non-motor symptoms improve over time and if results are sustainable.
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Affiliation(s)
- Annie Bane
- Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, USA
| | - Lorraine Wilson
- Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, USA
| | - Jill Jumper
- Department of Physical Therapy, Hardin-Simmons University, Abilene, TX, USA
| | - Lindsay Spindler
- Department of Kinesiology, Health and Recreation, Hardin-Simmons University, Abilene, TX, USA
| | - Pricilla Wyatt
- Texas Tech University Health Science Center, Abilene, TX, USA
| | - Darryn Willoughby
- Physicians Assistant Program and the Exercise and Sport Science Department, University of Mary Hardin-Baylor, Belton, TX, USA
- School of Medicine, Baylor College of Medicine, Temple, TX, USA
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MEMİŞ Z, ÇEVİK N, ACAR H, GÜNAYDIN S, ÇOKAR Ö. The First Electrophysiological Abnormality in New-onset DM: Autonomic Tests. Noro Psikiyatr Ars 2022; 59:197-200. [PMID: 36160073 PMCID: PMC9466630 DOI: 10.29399/npa.27952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/08/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Conventional nerve conduction studies (NCS) are used in the electrodiagnosis of diabetic neuropathy. The aim of our study was to investigate diabetic small fiber neuropathy in newly diagnosed type 2 diabetes mellitus (DM) patient group by using autonomic tests. METHODS Our study was conducted on 49 patients (24 female, 25 male) who were newly diagnosed with type 2 DM in the last 3 months and a control group of 25 volunteers. In addition to conventional NCS, sympathetic skin response (SSR) and RR interval variability (RRIV) tests were performed. RESULTS The mean upper limb SSR latency of the patient group was more prolonged than that of the control group, whereas the mean lower limb SSR amplitude of the patient group was lower than that of the control group (p=0.002, p<0.001; respectively). The mean resting (R) and deep inspiration (D) RRIV values of the patient group were lower than that of the control group (p=0.037, p<0.001; respectively). In the patient group, the mean R-RRIV and D-RRIV values were found to be positively correlated with the lower limb SSR amplitude (r=0.006, r=0.011; respectively). The mean R-RRIV and D-RRIV change rate of the patient group (D-R)/R was found to be lower than that of the control group (p=0.002). CONCLUSION In our study, we showed that autonomic function tests were impaired in newly diagnosed type 2 DM patients who were found not to have diabetic polyneuropathy by standard electrophysiological study. These findings suggest that standard electrophysiological tests are not sufficient in the early stages of the disease.
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Affiliation(s)
- Zülfikar MEMİŞ
- Haseki Research and Training Hospital, Neurology Clinics, İstanbul, Turkey
| | - Nihat ÇEVİK
- Şanlıurfa Education and Research Hospital, Neurology Clinics, Şanlıurfa, Turkey
| | - Hürtan ACAR
- Haseki Research and Training Hospital, Neurology Clinics, İstanbul, Turkey
| | - Sefer GÜNAYDIN
- Haseki Research and Training Hospital, Neurology Clinics, İstanbul, Turkey
| | - Özlem ÇOKAR
- Haseki Research and Training Hospital, Neurology Clinics, İstanbul, Turkey
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Méndez-Morales S, Pérez-De Marco J, Rodríguez-Cortés O, Flores-Mejía R, Martínez-Venegas M, Sánchez-Vera Y, Tamay-Cach F, Lomeli-Gonzaléz J, Emilio Reyes A, Lehman-Mendoza R, Martínez-Arredondo H, Vazquez-Dávila R, Torres-Roldan J, Correa-Basurto J, Arellano-Mendoza M. Diabetic neuropathy: Molecular approach a treatment opportunity. Vascul Pharmacol 2022; 143:106954. [DOI: 10.1016/j.vph.2022.106954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/15/2022]
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Klimontov VV, Saik OV, Korbut AI. Glucose Variability: How Does It Work? Int J Mol Sci 2021; 22:ijms22157783. [PMID: 34360550 PMCID: PMC8346105 DOI: 10.3390/ijms22157783] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 02/07/2023] Open
Abstract
A growing body of evidence points to the role of glucose variability (GV) in the development of the microvascular and macrovascular complications of diabetes. In this review, we summarize data on GV-induced biochemical, cellular and molecular events involved in the pathogenesis of diabetic complications. Current data indicate that the deteriorating effect of GV on target organs can be realized through oxidative stress, glycation, chronic low-grade inflammation, endothelial dysfunction, platelet activation, impaired angiogenesis and renal fibrosis. The effects of GV on oxidative stress, inflammation, endothelial dysfunction and hypercoagulability could be aggravated by hypoglycemia, associated with high GV. Oscillating hyperglycemia contributes to beta cell dysfunction, which leads to a further increase in GV and completes the vicious circle. In cells, the GV-induced cytotoxic effect includes mitochondrial dysfunction, endoplasmic reticulum stress and disturbances in autophagic flux, which are accompanied by reduced viability, activation of apoptosis and abnormalities in cell proliferation. These effects are realized through the up- and down-regulation of a large number of genes and the activity of signaling pathways such as PI3K/Akt, NF-κB, MAPK (ERK), JNK and TGF-β/Smad. Epigenetic modifications mediate the postponed effects of glucose fluctuations. The multiple deteriorative effects of GV provide further support for considering it as a therapeutic target in diabetes.
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Affiliation(s)
- Vadim V. Klimontov
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia; (O.V.S.); (A.I.K.)
- Correspondence:
| | - Olga V. Saik
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia; (O.V.S.); (A.I.K.)
- Laboratory of Computer Proteomics, Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences (IC&G SB RAS), 630090 Novosibirsk, Russia
| | - Anton I. Korbut
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia; (O.V.S.); (A.I.K.)
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Tuttolomondo A, Del Cuore A, La Malfa A, Casuccio A, Daidone M, Maida CD, Di Raimondo D, Di Chiara T, Puleo MG, Norrito R, Guercio G, Pinto A. Assessment of heart rate variability (HRV) in subjects with type 2 diabetes mellitus with and without diabetic foot: correlations with endothelial dysfunction indices and markers of adipo-inflammatory dysfunction. Cardiovasc Diabetol 2021; 20:142. [PMID: 34261479 PMCID: PMC8281716 DOI: 10.1186/s12933-021-01337-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Some studies have suggested that patients with diabetes and foot complications have worse cardiovascular and cerebrovascular risk profiles, higher degrees of endothelial dysfunction and arterial stiffness and a higher inflammatory background than patients with diabetes without diabetic foot complications. Patients with diabetes mellitus have an alteration in the sympathovagal balance as assessed by means of heart rate variability (HRV) analysis, which is also related to the presence of endothelial dysfunction. Other studies suggest a possible role of inflammation coexisting with the alteration in the sympathovagal balance in favor of the atherosclerotic process in a mixed population of healthy subjects of middle and advanced age. Aims The aim of this study was to evaluate the degree of alteration of sympathovagal balance, assessed by HRV analysis, in a cohort of patients with diabetes mellitus with diabetic foot and in control subjects without diabetic foot compared with a population of healthy subjects and the possible correlation of HRV parameters with inflammatory markers and endothelial dysfunction indices. Methods We enrolled all patients with diabetic ulcerative lesions of the lower limb in the Internal Medicine with Stroke Care ward and of the diabetic foot outpatient clinic of P. Giaccone University Hospital of Palermo between September 2019 and July 2020. 4-h ECG Holter was performed. The following time domain HRV measures were analyzed: average heart rate, square root of the mean of successive differences of NN (RMSSD), standard deviation or square root of the variance (SD), and standard deviation of the means of the NN intervals calculated over a five-minute period (SDANN/5 min). The LF/HF ratio was calculated, reactive hyperemia was evaluated by endo-PAT, and serum levels of vaspine and omentin-1 were assessed by blood sample collection. Results 63 patients with diabetic foot, 30 patients with diabetes and without ulcerative complications and 30 patients without diabetes were enrolled. Patients with diabetic ulcers showed lower mean diastolic blood pressure values than healthy controls, lower MMSE scores corrected for age, lower serum levels of omentin-1, lower RHI values, higher body weight values and comparable body height values, HF% and LF/HF ratio values. We also reported a negative correlation between the RHI value and HRV indices and the expression of increased parasympathetic activity (RMSDD and HF%) in subjects with diabetic foot and a statistically significant positive correlation with the LF/HF ratio and the expression of the sympathovagal balance. Discussion Patients with diabetic foot show a higher degree of activation of the parasympathetic system, expressed by the increase in HF values, and a lower LF/HF ratio. Our findings may corroborate the issue that a parasympathetic dysfunction may have a possible additive role in the pathogenesis of other vascular complications in subjects with diabetic foot.
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Affiliation(s)
- Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy. .,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy.
| | - Alessandro Del Cuore
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Alessandro La Malfa
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Mario Daidone
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Carlo Domenico Maida
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Domenico Di Raimondo
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Tiziana Di Chiara
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Maria Grazia Puleo
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Rosario Norrito
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Giovanni Guercio
- Department of Surgical Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Antonio Pinto
- Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
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Yan YJ, Tsai YC, Ko ML, Lee NC, Chiou JC, Ou-Yang M. Quantitative examination of early diabetes by light-emitting diodes light-induced pupillary light reflex. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:014101. [PMID: 33514206 DOI: 10.1063/5.0030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the abnormal pupillary light reflex in patients with early diabetes mellitus (DM) without retinopathy by using a custom-made noninvasive portable pupilometer. The pupilometer recorded and analyzed the pupillary light reflex. Two light intensities, 0.2 cd and 1.2 cd, and four wavelengths of stimulus light-white (400 nm-800 nm), red (640 ± 5 nm), green (534 ± 5 nm), and blue (470 ± 5 nm)-were used to stimulate the pupil for 10 ms. The pupillary response was recorded for 15 s. A total of 40 healthy people and 40 people with DM without retinopathy participated in the experiment at the National Taiwan University Hospital. The mean and standard deviation of DM duration were 4.5 years and 3.9 years. Of the 16 indices, the duration that pupil restores from its minimum size to half of its resting size (DRP), maximum pupil restoration velocity (MRV), and average restoration velocity (ARV) exhibited the most significant differences between the healthy people and those with DM. Compared with healthy participants, DRP was 16.33% higher, and MRV and ARV were 17.45% and 4.58% lower, respectively, in those with DM. This might be attributable to the sympathetic nervous system (SNS) controlling the dilator muscle during the dark-adapted period and relaxing the pupil; the SNS had few degenerated nerve endings in people with DM. The three aforementioned indices might be used to evaluate the severity of autonomic neuropathy in early DM.
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Affiliation(s)
- Y J Yan
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - Y C Tsai
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - M L Ko
- National Taiwan University Hospital Hsinchu Branch, Hsinchu 300, Taiwan
| | - N C Lee
- National Taiwan University Hospital, Taipei 100, Taiwan
| | - J C Chiou
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - M Ou-Yang
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
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Baranowska-Jurkun A, Matuszewski W, Bandurska-Stankiewicz E. Chronic Microvascular Complications in Prediabetic States-An Overview. J Clin Med 2020; 9:E3289. [PMID: 33066307 PMCID: PMC7602111 DOI: 10.3390/jcm9103289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes.
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Affiliation(s)
- Angelika Baranowska-Jurkun
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland; (W.M.); (E.B.-S.)
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8
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Tentolouris A, Eleftheriadou I, Tzeravini E, Tsilingiris D, Paschou SA, Siasos G, Tentolouris N. Endothelium as a Therapeutic Target in Diabetes Mellitus: From Basic Mechanisms to Clinical Practice. Curr Med Chem 2020; 27:1089-1131. [PMID: 30663560 DOI: 10.2174/0929867326666190119154152] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
Endothelium plays an essential role in human homeostasis by regulating arterial blood pressure, distributing nutrients and hormones as well as providing a smooth surface that modulates coagulation, fibrinolysis and inflammation. Endothelial dysfunction is present in Diabetes Mellitus (DM) and contributes to the development and progression of macrovascular disease, while it is also associated with most of the microvascular complications such as diabetic retinopathy, nephropathy and neuropathy. Hyperglycemia, insulin resistance, hyperinsulinemia and dyslipidemia are the main factors involved in the pathogenesis of endothelial dysfunction. Regarding antidiabetic medication, metformin, gliclazide, pioglitazone, exenatide and dapagliflozin exert a beneficial effect on Endothelial Function (EF); glimepiride and glibenclamide, dipeptidyl peptidase-4 inhibitors and liraglutide have a neutral effect, while studies examining the effect of insulin analogues, empagliflozin and canagliflozin on EF are limited. In terms of lipid-lowering medication, statins improve EF in subjects with DM, while data from short-term trials suggest that fenofibrate improves EF; ezetimibe also improves EF but further studies are required in people with DM. The effect of acetylsalicylic acid on EF is dose-dependent and lower doses improve EF while higher ones do not. Clopidogrel improves EF, but more studies in subjects with DM are required. Furthermore, angiotensin- converting-enzyme inhibitors /angiotensin II receptor blockers improve EF. Phosphodiesterase type 5 inhibitors improve EF locally in the corpus cavernosum. Finally, cilostazol exerts favorable effect on EF, nevertheless, more data in people with DM are required.
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Affiliation(s)
- Anastasios Tentolouris
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Tsilingiris
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Stavroula A Paschou
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Li YP, Yan ZQ, Han LP, Yin AL, Xu JY, Zhai YR, Hao S, Zhang L, Xie Y. The Association Between Phosphorylated Neurofilament Heavy Chain (pNF-H) and Small Fiber Neuropathy (SFN) in Patients with Impaired Glucose Tolerance. Diabetes Ther 2020; 11:71-81. [PMID: 31673971 PMCID: PMC6965567 DOI: 10.1007/s13300-019-00716-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Small fiber neuropathy (SFN)-the early stage of diabetic peripheral neuropathy (DPN)-progresses gradually and is difficult to diagnose using neurophysiological tests. To facilitate the early diagnosis of SFN, biomarkers for SFN must be identified. The purpose of this study was to investigate the characteristics of SFN in prediabetic patients and the relationship between pNF-H and SFN. METHODS 44 IGT patients (inpatients and outpatients) were selected at random. 33 healthy subjects served as controls. Data on clinical characteristics and laboratory parameters were collected. Quantitative sensory testing (QST), electromyography (EMG), and Sudoscan were performed, and pNF-H was measured by ELISA. RESULTS 24 of the 44 patients with impaired glucose tolerance (IGT) were diagnosed with SFN according to the modified Toronto Diabetic Neuropathy Expert Group consensus criteria. The thermal sensory thresholds of the IGT-SFN group were significantly different from those of the CTRL group (p < 0.05), except for the heat pain threshold. The sensory nerve action potential (SNAP) of the sural nerve was 12.39 in the IGT-SFN group, which was significantly lower than those in the other groups. No significant difference in nerve conduction velocity (NCV) was observed among the three groups. The electrochemical skin conductance (ESC) in the IGT-SFN group was 69.78 ± 14.03uS, which was significantly lower than that in the CTRL group. The pNF-H in the IGT-SFN group was 170.6 (140.0, 223.6) pg/ml, which was significantly higher than those in the CTRL and IGT-non-SFN groups (76.55 and 64.7 pg/ml, respectively). Multivariate regression analysis demonstrated that pNF-H and 2h plasma glucose were independently correlated with SFN; the ORs (95% CI) were 1.429 (1.315, 1.924) and 2.375 (1.157, 4.837), respectively. CONCLUSIONS Serum pNF-H may be associated with SFN in IGT patients, and serum pNF-H could therefore serve as a sensitive biomarker for the detection of SFN.
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Affiliation(s)
- Yu-Peng Li
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
- Tianjin Institute of Endocrinology, Tianjin, China.
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China.
| | - Zhong-Qing Yan
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Li-Ping Han
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Ai-Li Yin
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Jin-Yong Xu
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Ya-Ran Zhai
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Sai Hao
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Lin Zhang
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Yun Xie
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
- Tianjin Institute of Endocrinology, Tianjin, China.
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China.
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Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther 2019; 10:1995-2021. [PMID: 31552598 PMCID: PMC6848658 DOI: 10.1007/s13300-019-00693-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a major complication of type 1 and type 2 diabetes mellitus (T1DM and T2DM). The increased morbidity, cardiovascular and all-cause mortality associated with CAN is established from numerous epidemiological studies. However, CAN is increasingly recognised in people with prediabetes (pre-DM) and the metabolic syndrome (MetS) with a reported prevalence up to 11% and 24% respectively. CAN is associated with components of MetS including hypertension and obesity, predating hyperglycaemia. The aetiology of CAN is multifactorial and there is a reciprocal relationship with insulin resistance and MetS. Obstructive sleep apnoea (OSA) is also associated with CAN possibly through MetS and an independent mechanism. An estimated global prevalence of the impaired glucose tolerance (IGT) form of pre-DM of 587 million people by 2045 means CAN will become a major clinical problem. CAN is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Screening for CAN in pre-DM using risk scores with analysis of heart rate variability (HRV) or Sudoscan is important to allow earlier treatment at a reversible stage. The link between obesity and CAN highlights the therapeutic potential of lifestyle interventions including diet and physical activity to reverse MetS and prevent CAN. Weight loss achieved using these dietary and exercise lifestyle interventions improves the sympathetic and parasympathetic HRV indices of cardiac autonomic function. Further research is needed to identify high-risk populations of people with pre-DM or obesity that might benefit from targeted pharmacotherapy including metformin, sodium/glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) analogues. Bariatric surgery also improves HRV through weight loss which might also prevent CAN in severe obesity. This article reviews the literature on CAN in obesity, pre-DM and MetS, to help determine a rationale for screening, early intervention treatment and formulate future research questions in this highly prevalent condition.
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Affiliation(s)
| | | | - Uazman Alam
- Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
| | - Daniel J Cuthbertson
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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11
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Kumanan T, Sujanitha V, Rajeshkannan N, Nisahan B. Nocturnal systolic blood pressure pattern of type 2 diabetic hypertensive men with erectile dysfunction: a cross sectional study from Northern Sri Lanka. BMC Res Notes 2019; 12:696. [PMID: 31653261 PMCID: PMC6814983 DOI: 10.1186/s13104-019-4740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/16/2019] [Indexed: 11/14/2022] Open
Abstract
Objective This small scale cross-sectional study was done to identify the common systolic blood pressure pattern (dipping or non-dipping) among type 2 diabetic men with coexisting hypertension and erectile dysfunction(ED). A recent study in the same setting showed that prevalence of ED was high among diabetic men and co-existing hypertension was identified as an independent risk factor. There was a postulation about an association between ED and non-dipping nocturnal blood pressure pattern. So ambulatory blood pressure measurements (ABPM) was obtained for participants to test this prediction. Data was analysed using SPSS 25 Version. Results Among 29 participants who underwent ABPM, 21 showed non-dipping pattern of nocturnal systolic blood pressure (72.4%; CI 54.3–86.3). Mean SBP of participants was 125.55 +_14.1 and Mean DBP was 81.5 + _12.82. There was no statistical difference observed in mean SBP and DBP between patients with dipping nocturnal SBP and non-dipping pattern (P > 0.05). Variability of SBP was high among the participants (Mean SD-11.96 +/_2.74) and DBP also showed relatively high variability (SD-9.28 +/_2.9). Mean dipping percentage of the SBP during sleep was 5.54 +/_6.66. A significant difference in heart rate (HR) between patients with non-dipping and dipping pattern was noted (P-0.034).
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Affiliation(s)
| | - Vathulan Sujanitha
- Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
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12
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Xia T, Yang Y, Li W, Tang Z, Li Z, Guo Y. Acupoint catgut embedding for diabetic gastroparesis: A protocol of systematic review. Medicine (Baltimore) 2019; 98:e17718. [PMID: 31651905 PMCID: PMC6824757 DOI: 10.1097/md.0000000000017718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic gastroparesis (DG) is a common complication to diabetes mellitus (DM). A lot of clinical researches have focused on acupoint catgut embedding for diabetic gastroparesis. However, there is no systematic review and meta-analysis has been conducted. We aim to systematically review the effect of acupoint catgut embedding on diabetic gastroparesis. METHODS The databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Ovid LWW, EMBASE, CNKI, Wanfang Database will be searched. Studies published from the time when the database establishment to July 2019 will be retrieved. Randomized controlled clinical trials and quasi-randomized controlled trials on acupoint catgut embedding for diabetic gastroparesis will be included. The primary outcomes are gastroparesis Cardinal Symptom Index (GCSI) or a similar scale to score dyspeptic symptoms. RevMan V.5.3 software will be used to perform the analyses. RESULTS This study will provide a high-quality synthesis of the effectiveness and safety of acupoint catgut embedding for diabetic gastroparesis. CONCLUSION This systematic review will provide a high-quality evidence to judge whether the acupoint catgut embedding is beneficial to treat diabetic gastroparesis. PROSPERO REGISTRATION NUMBER CRD42019140951.
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Affiliation(s)
- Tingwei Xia
- Basic Medical College, Chengdu University of TCM
- Department of TCM, Qingyang District People's Hospital, Chengdu, Sichuan Province, China
| | - Yue Yang
- Department of TCM, Qingyang District People's Hospital, Chengdu, Sichuan Province, China
| | - Weihong Li
- Basic Medical College, Chengdu University of TCM
| | - Zhaohui Tang
- Basic Medical College, Chengdu University of TCM
| | - Zongrun Li
- Basic Medical College, Chengdu University of TCM
| | - Yongsong Guo
- Basic Medical College, Chengdu University of TCM
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13
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Bhati P, Alam R, Moiz JA, Hussain ME. Subclinical inflammation and endothelial dysfunction are linked to cardiac autonomic neuropathy in type 2 diabetes. J Diabetes Metab Disord 2019; 18:419-428. [PMID: 31890667 DOI: 10.1007/s40200-019-00435-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023]
Abstract
Purpose The present study aimed to examine association between inflammatory and endothelial function biomarkers and indices of cardiac autonomic control in T2DM patients. Methods 50 T2DM patients were recruited for this study. For cardiac autonomic function, cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV) analysis was performed. Blood samples were collected for evaluating inflammatory and endothelial function biomarkers. Multivariable linear regression analysis adjusted for diabetes duration, glycemic control, waist circumference, hypertension, dyslipidemia, metformin, and statins was performed to examine the association between the biomarkers and cardiac autonomic function parameters. Results Interleukin-6 was inversely related to total power (p = .009) and low frequency power (p = .04). Interleukin-18 and high sensitivity C-reactive protein inversely correlated with measures of cardiac vagal control (p < .05). Both nitric oxide and endothelial nitric oxide synthase were positively linked with cardiac vagal control indices (p < .05) whereas endothelin-1 did not show any independent association with cardiac autonomic function parameters. Conclusions Biomarkers of inflammation and endothelial function are associated with measures of cardiac vagal control and global HRV which suggest that there is some pathophysiological link between subclinical inflammation, endothelial dysfunction and cardiac autonomic dysfunction in T2DM.
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Affiliation(s)
- Pooja Bhati
- 1Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
| | - Rizwan Alam
- 2Deen Dayal Upadhyay Kaushal Kendra, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
| | - Jamal Ali Moiz
- 1Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
| | - M Ejaz Hussain
- 1Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
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14
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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15
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Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J 2019; 43:3-30. [PMID: 30793549 PMCID: PMC6387879 DOI: 10.4093/dmj.2018.0259] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.
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Affiliation(s)
- Vincenza Spallone
- Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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16
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Guo J, Sheng X, Dan Y, Xu Y, Zhang Y, Ji H, Wang J, Xu Z, Che H, Li G, Liang S, Li G. Involvement of P2Y 12 receptor of stellate ganglion in diabetic cardiovascular autonomic neuropathy. Purinergic Signal 2018; 14:345-357. [PMID: 30084083 DOI: 10.1007/s11302-018-9616-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/26/2018] [Indexed: 12/22/2022] Open
Abstract
Diabetes as a chronic epidemic disease with obvious symptom of hyperglycemia is seriously affecting human health globally due to the diverse diabetic complications. Diabetic cardiovascular autonomic neuropathy (DCAN) is a common complication of both type 1 and type 2 diabetes and incurs high morbidity and mortality. However, the underlying mechanism for DCAN is unclear. It is well known that purinergic signaling is involved in the regulation of cardiovascular function. In this study, we examined whether the P2Y12 receptor could mediate DCAN-induced sympathetic reflexes. Our results revealed that the abnormal changes of blood pressure, heart rate, heart rate variability, and sympathetic nerve discharge were improved in diabetic rats treated with P2Y12 short hairpin RNA (shRNA). Meanwhile, the expression of P2Y12 receptor, interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and connexin 43 (Cx43) in stellate ganglia (SG) was decreased in P2Y12 shRNA-treated diabetic rats. In addition, knocking down the P2Y12 receptor also inhibited the activation of p38 MARK in the SG of diabetic rats. Taken together, these findings demonstrated that P2Y12 receptor in the SG may participate in developing diabetic autonomic neuropathy, suggesting that the P2Y12 receptor could be a potential therapeutic target for the treatment of DCAN.
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Affiliation(s)
- Jingjing Guo
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China
| | - Xuan Sheng
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China
| | - Yu Dan
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China
| | - Yurong Xu
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China
| | - Yuanruohan Zhang
- Queen Mary School, Medical College of Nanchang University, Nanchang, 330006, China
| | - Huihong Ji
- Department of the First Clinical, Medical College of Nanchang University, Nanchang, 330006, China
| | - Jiayue Wang
- Department of the First Clinical, Medical College of Nanchang University, Nanchang, 330006, China
| | - Zixi Xu
- Department of the First Clinical, Medical College of Nanchang University, Nanchang, 330006, China
| | - Hongyu Che
- Queen Mary School, Medical College of Nanchang University, Nanchang, 330006, China
| | - Guodong Li
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China.,Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shangdong Liang
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China
| | - Guilin Li
- Department of Physiology, Medical College of Nanchang University, Nanchang, 330006, China.
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17
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Matsutani D, Sakamoto M, Iuchi H, Minato S, Suzuki H, Kayama Y, Takeda N, Horiuchi R, Utsunomiya K. Glycemic variability in continuous glucose monitoring is inversely associated with baroreflex sensitivity in type 2 diabetes: a preliminary report. Cardiovasc Diabetol 2018. [PMID: 29514695 PMCID: PMC5840775 DOI: 10.1186/s12933-018-0683-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background It is presently unclear whether glycemic variability (GV) is associated with baroreflex sensitivity (BRS), which is an early indicator of cardiovascular autonomic neuropathy. The present study is the first to examine the relationships between BRS and GV measured using continuous glucose monitoring (CGM). Methods This was a multicenter, prospective, open-label clinical trial. A total of 102 patients with type 2 diabetes were consecutively recruited for this study. GV was assessed by measuring the standard deviation (SD), glucose coefficient of variation (CV), and the mean amplitude of glycemic excursions (MAGE) during CGM. The BRS was analyzed from electrocardiogram and blood pressure recordings using the sequence method on the first day of hospitalization. Results A total of 94 patients (mean diabetes duration 9.7 ± 9.6 years, mean HbA1c 61.0 ± 16.8 mmol/mol [7.7 ± 1.5%]) were analyzed. In the univariate analysis, CGM-SD (r = − 0.375, p = 0.000), CGM-CV (r = − 0.386, p = 0.000), and MAGE (r = − 0.395, p = 0.000) were inversely related to BRS. In addition to GV, the level of BRS correlated with the coefficient of variation in the R–R intervals (CVR-R) (r = 0.520, p = 0.000), heart rate (HR) (r = − 0.310, p = 0.002), cardio-ankle vascular index (CAVI) (r = − 0.326, p = 0.001), age (r = − 0.519, p = 0.000), and estimated glomerular filtration rate (eGFR) (r = 0.276, p = 0.007). Multiple regression analysis showed that CGM-CV and MAGE were significantly related to a decrease in BRS. These findings remained after adjusting the BRS for age, sex, hypertension, dyslipidemia, HR, eGFR, CAVI, and CGM-mean glucose. Additionally, BRS was divided according to quartiles of the duration of diabetes (Q1–4). BRS decreased after a 2-year duration of diabetes independently of age and sex. Conclusions GV was inversely related to BRS independently of blood glucose levels in type 2 diabetic patients. Measurement of BRS may have the potential to predict CV events in consideration of GV. Trial registration UMIN Clinical Trials Registry UMIN000025964, 28/02/2017 Electronic supplementary material The online version of this article (10.1186/s12933-018-0683-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daisuke Matsutani
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaya Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hiroyuki Iuchi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Souichirou Minato
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hirofumi Suzuki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yosuke Kayama
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norihiko Takeda
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryuzo Horiuchi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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18
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Hansen CS, Vistisen D, Jørgensen ME, Witte DR, Brunner EJ, Tabák AG, Kivimäki M, Roden M, Malik M, Herder C. Adiponectin, biomarkers of inflammation and changes in cardiac autonomic function: Whitehall II study. Cardiovasc Diabetol 2017; 16:153. [PMID: 29195493 PMCID: PMC5710029 DOI: 10.1186/s12933-017-0634-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/08/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Biomarkers of inflammation and adiponectin are associated with cardiovascular autonomic neuropathy (CAN) in cross-sectional studies, but prospective data are scarce. This study aimed to assess the associations of biomarkers of subclinical inflammation and adiponectin with subsequent changes in heart rate (HR) and heart rate variability (HRV) in non-diabetic and diabetic individuals. METHODS Data are based on up to 25,050 person-examinations for 8469 study participants of the Whitehall II cohort study. Measures of CAN included HR and several HRV indices. Associations between baseline serum levels of high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, IL-1 receptor antagonist (IL-1Ra) and adiponectin and 5-year changes in HR and six HRV indices were estimated using mixed-effects models adjusting for age, sex, ethnicity, body mass index (BMI), metabolic covariates and medication. A modifying effect of diabetes was tested. RESULTS Higher levels of IL-1Ra were associated with higher increases in HR. Additional associations with measures of HRV were observed for hsCRP, IL-6 and IL-1Ra, but these associations were explained by BMI and other confounders. Associations between adiponectin, HR and HRV differed depending on diabetes status. Higher adiponectin levels were associated with more pronounced decreases in HR and increases in three measures of HRV reflecting both sympathetic and vagal activity, but these findings were limited to individuals with type 2 diabetes. CONCLUSIONS Higher IL-1Ra levels appeared as novel risk marker for increases in HR. Higher adiponectin levels were associated with a more favourable development of cardiovascular autonomic function in individuals with type 2 diabetes independently of multiple confounders.
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Affiliation(s)
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 2-4, 2820, Gentofte, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 2-4, 2820, Gentofte, Denmark
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, UK.,First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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19
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Choi JA, Kim HW, Kwon JW, Shim YS, Jee DH, Yun JS, Ahn YB, Park CK, Ko SH. Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes. PLoS One 2017; 12:e0174377. [PMID: 28334035 PMCID: PMC5363937 DOI: 10.1371/journal.pone.0174377] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022] Open
Abstract
Background To investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications. Methods We studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN. Results We compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters. Conclusions Cardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.
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Affiliation(s)
- Jin A. Choi
- Department of Ophthalmology and Visual Science St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Won Kim
- Department of Ophthalmology and Visual Science St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Woo Kwon
- Department of Ophthalmology and Visual Science St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun-sub Shim
- Department of Ophthalmology and Visual Science St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hyun Jee
- Department of Ophthalmology and Visual Science St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kee Park
- Department of Ophthalmology and Visual Science Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail: (CKP); (SHK)
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail: (CKP); (SHK)
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20
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Kamshilin AA, Sidorov IS, Babayan L, Volynsky MA, Giniatullin R, Mamontov OV. Accurate measurement of the pulse wave delay with imaging photoplethysmography. BIOMEDICAL OPTICS EXPRESS 2016; 7:5138-5147. [PMID: 28018731 PMCID: PMC5175558 DOI: 10.1364/boe.7.005138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/22/2016] [Accepted: 10/31/2016] [Indexed: 05/30/2023]
Abstract
Assessment of the cardiovascular parameters using noncontact video-based or imaging photoplethysmography (IPPG) is usually considered as inaccurate because of strong influence of motion artefacts. To optimize this technique we performed a simultaneous recording of electrocardiogram and video frames of the face for 36 healthy volunteers. We found that signal disturbances originate mainly from the stochastically enhanced dichroic notch caused by endogenous cardiovascular mechanisms, with smaller contribution of the motion artefacts. Our properly designed algorithm allowed us to increase accuracy of the pulse-transit-time measurement and visualize propagation of the pulse wave in the facial region. Thus, the accurate measurement of the pulse wave parameters with this technique suggests a sensitive approach to assess local regulation of microcirculation in various physiological and pathological states.
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Affiliation(s)
- Alexei A. Kamshilin
- Department of Computer Photonics and Videomatics, ITMO University, St. Petersburg 197101, Russia
| | - Igor S. Sidorov
- Department of Computer Photonics and Videomatics, ITMO University, St. Petersburg 197101, Russia
| | - Laura Babayan
- Department of Computer Photonics and Videomatics, ITMO University, St. Petersburg 197101, Russia
- Department of Neurology and Neurosurgery, Pavlov First Saint Petersburg State Medical University, St. Petersburg 197022, Russia
| | - Maxim A. Volynsky
- Department of Computer Photonics and Videomatics, ITMO University, St. Petersburg 197101, Russia
| | - Rashid Giniatullin
- Department of Computer Photonics and Videomatics, ITMO University, St. Petersburg 197101, Russia
- Department of Neurobiology, University of Eastern Finland, 70210 Kuopio, Finland
- Laboratory of Neurobiology, Kazan Federal University, Kazan 7208, Russia
| | - Oleg V. Mamontov
- Department of Computer Photonics and Videomatics, ITMO University, St. Petersburg 197101, Russia
- Department of Circulation Physiology, Federal Almazov North-West Medical Research Centre, St. Petersburg 197341, Russia
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Vukomanovic V, Tadic M, Suzic-Lazic J, Kocijancic V, Celic V. The relationship between heart rate variability and left ventricular layer-specific deformation in uncomplicated diabetic patients. Int J Cardiovasc Imaging 2016; 33:481-490. [PMID: 27853970 DOI: 10.1007/s10554-016-1023-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/12/2016] [Indexed: 12/25/2022]
Abstract
The aim of this study was to investigate heart rate variability (HRV) and left ventricular (LV) remodeling in uncomplicated diabetic patients. Furthermore, we sought to investigate the association between HRV indices and LV structural, functional and mechanical parameters. This cross-sectional study included 50 uncomplicated patients with type 2 diabetes and 40 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). LV structure and diastolic function were significantly deteriorated in the diabetic patients comparing with the controls. LV global longitudinal, circumferential and radial strains were significantly reduced in the diabetic group. LV endocardial, mid-miocardial and epicardial longitudinal and circumferential strains were significantly decreased, whereas LV twist was significantly increased, in the diabetic patients; 24-h, daytime and nighttime heart rates were higher in the diabetic patients. All parameters of time and frequency domain of HRV were reduced in the diabetic subjects. LV mass index, mitral E/e' ratio and 2DE LV endocardial and mid-miocardial longitudinal and circumferential strains correlated with HRV parameters. A multivariate regression analysis showed that E/e' ratio and 2DE LV layer-specific strains were associated with HRV parameters independently of age, BMI, systolic blood pressure and LV mass index. HRV and LV mechanics are significantly deteriorated in uncomplicated diabetic individuals. Parameters of LV remodeling are independently associated with HRV indices, which could indicate the importance of HRV determination in diabetics.
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Affiliation(s)
- Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Doktora Subotica 6, 11000, Belgrade, Serbia.
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vesna Kocijancic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Doktora Subotica 6, 11000, Belgrade, Serbia
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