Endocrine Abstracts

Background and aims: In 2005, experts from the IDF assigned the risk of developing coronary heart disease in patients with type 1 diabetes mellitus (DM1) at age of 30 and over or patients with DM1 with kidney damage equal to the patients with type 2 diabetes mellitus. The need for a non-invasive preclinical marker for identifying patients with the increased risk of cardiovascular disease is obvious. The assessment of arterial stiffness can play a role of such marker. The aim of this study was to assess the effect of microvascular complications of DM1 on arterial stiffness in patients with DM1.

Materials and methods: We examined 73 patients with DM1 (age 28.1±6.4; HbA₁c 8.9±1.8%) with normoalbuminuria AER in the morning urine <20 mg/l (n=40); microalbuminuria AER<199 mg/l (n=24); macroalbuminuria AER≥200 mg/l (n=9). The decrease of glomerular filtration rate (GFR)<60 ml/min/1.73 m² was noted in eight patients, and GFR≥60 ml/min/1.73 m² was registered in 65 patients. Control group included 25 healthy subjects (age 26.3±4.2). The study included an evaluation of the contour pulse wave analysis with the determination of the stiffness index of the arterial wall-the augmentation index (Alx75) on the unit. Additionally, all patients were assessed the thickness of the intima-media complex (TIM) and general clinical studies. Statistical analysis was performed with SPSS22.0, P<0.05.

Results: There was no statistical significant differences Alx75 between the DM1 group and the control group. Alx75 was significantly higher in patients with DM1 and diabetic nephropathy compared to patients without nephropathy (P=0.000). In the group of patients with GFR<60 ml/min/1.73 m², Alx75 was higher in comparison with the group with GFR ≥60 ml/min/1.73 m² (P=0.009). An increase of Alx75 was noted in patients with microalbuminuria compared to patients with normoalbuminuria (P=0.006), however, there were no significant difference during comparison of patients with DM1 without nephropathy with the control group. Alx75 was higher in patients with diabetic retinopathy compared to the patients without retinopathy(P=0.000), while no statistically significant difference was found during comparison the patients with type 1 diabetes without retinopathy and the control group (P=0.093). Alx75 was correlated positively with TIM (R=0.490; P=0.000); age (R=0.326; P=0.007); duration of DM1 (R=0.441; P=0.000); and albumin/creatinine ratio (R=0.369; P=0.004), Alx75 was correlated negatively with GFR (R=−0.301; P=0.015). Smoking status and arterial hypertension was not independently associated with increased arterial stiffness in patients with DM1.

Conclusion: An increase of the arterial stiffness index in the early stages of microvascular complications may be an early marker of macrovascular lesions even in patients without arterial hypertension.