Weight change and sulfonylurea therapy are related to 3 year change in microvascular function in people with type 2 diabetes
dc.contributor.author | Casanova, F | |
dc.contributor.author | Gooding, K | |
dc.contributor.author | Shore, A | |
dc.contributor.author | Adingupu, D | |
dc.contributor.author | Mawson, D | |
dc.contributor.author | Ball, C | |
dc.contributor.author | Anning, C | |
dc.contributor.author | Aizawa, K | |
dc.contributor.author | Gates, P | |
dc.contributor.author | Strain, W | |
dc.date.accessioned | 2020-02-17T14:50:23Z | |
dc.date.issued | 2020-03-17 | |
dc.description.abstract | Aims: Although cardiovascular disease is the biggest cause of mortality in people with diabetes, microvascular complications have a significant impact on quality of life and financial burden of the disease. Little is known about the progression of microvascular dysfunction in the early stages of type 2 diabetes mellitus before the occurrence of clinically apparent complications. We aimed to explore this in a population with diabetes and general population sample. Methods: Demographics were collected in 154 participants with type 2 diabetes and in a further 99 participants without type 2 diabetes. Skin microvascular endothelium dependent response to iontophoresis of acetylcholine (ACh) and endothelium independent responses to sodium nitroprusside (SNP) were measured using laser Doppler fluximetry. All assessments were repeated 3 years later. Results: People with type 2 diabetes had impaired endothelial dependent microvascular response compared to those without (Area under the curve 93.8(95% CI 88.1 -99.4) vs 112(102 -121) arbitrary units per minute(au/min), p <0.001 for those with vs without diabetes respectively). Similarly endothelial independent responses were attenuated in those with diabetes (63.2(59.2 – 67.2) vs. 75.1(67.8 – 82.4)au/min respectively, p = 0.002). Mean microvascular function declined over 3 years in both groups to a similar degree (p for interaction 0.74 for response to ACh and 0.69 for response to SNP). In those with diabetes, use of sulphonylurea was associated with greater decline (p=0.022 after adjustment for co-prescriptions, change in HbA1c and weight), whereas improving glycaemic control was associated with less decline of endothelial dependent microvascular function (p=0.03). Otherwise, the determinants of microvascular decline were similar in those with and without diabetes. The principal determinant of change in microvascular function in the whole population was weight change over 3 years, such that those that lost ≥5% weight had very little decline in either endothelial dependent and independent function compared to those that were weight stable, whereas those who gained weight had a greater decline in function (change in endothelial dependent function was 1.2 (95% CI -13.2 – 15.7) au/min in those who lost weight; -15.8 (-10.5 – -21.0) au/min in those with stable weight and -37.8 (-19.4 – -56.2) au/min in those with weight gain (p trend <0.001). This association of weight change and change in endothelial function was driven by people with diabetes; in people without diabetes, the relationship was non-significant. Conclusion: Over three years, physiological change in weight was the greatest predictor of change in microvascular function. | en_GB |
dc.description.sponsorship | Innovative Medicines Initiative | en_GB |
dc.identifier.citation | Published online 17 March 2020 | en_GB |
dc.identifier.doi | 10.1007/s00125-020-05125-4 | |
dc.identifier.grantnumber | IMI-2008/115006 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/40883 | |
dc.language.iso | en | en_GB |
dc.publisher | Springer Verlag | en_GB |
dc.rights | Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. | |
dc.subject | Diabetes | en_GB |
dc.subject | Epidemiology | en_GB |
dc.subject | Population | en_GB |
dc.subject | Microvascular | en_GB |
dc.subject | Weight loss | en_GB |
dc.title | Weight change and sulfonylurea therapy are related to 3 year change in microvascular function in people with type 2 diabetes | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2020-02-17T14:50:23Z | |
dc.identifier.issn | 0012-186X | |
dc.description | This is the final version. Available on open access from Springer Verlag via the DOI in this record | en_GB |
dc.identifier.journal | Diabetologia | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2020-02-17 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2020-02-17 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2020-02-17T14:41:10Z | |
refterms.versionFCD | AM | |
refterms.dateFOA | 2020-03-18T12:11:27Z | |
refterms.panel | A | en_GB |
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Except where otherwise noted, this item's licence is described as Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.