Association of acute-phase reactants with arterial stiffness in patients with type 2 diabetes mellitus

BACKGROUND: The relationship between chronic low-grade inflammation and atherosclerotic progress in patients with diabetes mellitus has not been confirmed. We determined whether acute-phase reactants are associated with arterial stiffness in diabetic patients. METHODS: Relationships of blood inflammatory markers [high-sensitivity C-reactive protein (CRP), amyloid A protein (SAA), sialic acid, fibrinogen and white blood cells (WBC)] with atherosclerosis were investigated in a cross-sectional study using 114 subjects with type 2 diabetes. The degree of atherosclerosis was evaluated by arterial stiffness measured using cardio-ankle vascular index (CAVI), a new index of arterial stiffness, which is compatible with conventional aortic pulse-wave velocity. RESULTS: CRP, SAA, sialic acid, fibrinogen and WBC showed significant correlations with CAVI. CAVI was significantly higher in the highest tertile of sialic acid, fibrinogen and WBC compared with the lowest tertile or lowest and middle tertiles. This association was independent of age, sex and smoking. By logistic regression analysis, the highest levels of these acute-phase reactants showed increased risk of high CAVI, while CRP and SAA were not associated with an increased risk in this analysis. CAVI was also significantly correlated with duration of diabetes, blood pressure and serum total cholesterol. CONCLUSIONS: Acute-phase reactants, such as CRP, SAA, sialic acid, fibrinogen and WBC, are associated with arterial stiffness in patients with type 2 diabetes mellitus.     

ACE gene polymorphism as a prognostic indicator in patients with type 2 diabetes and established renal disease.

OBJECTIVE: To investigate whether the DD genotype is a predictor of mortality and of the decline in renal function in patients with type 2 diabetes and established nephropathy. RESEARCH DESIGN AND METHODS: A total of 56 such patients of Maltese Caucasian descent were recruited, and their ACE genotype was determined. Serum creatinine was estimated approximately every 4 months. The glomerular filtration rate (GFR) was calculated according to the Cockroft-Gault formula, and rate of change was determined by regression analysis. RESULTS: The rate of change in calculated GFR was -7.76 ml.min(-1).year(-1) in those with the DD genotype (n = 31) and -1.17 ml. min(-1). h(-1) in those with the ID or II genotype (n = 25) (P < 0.01). The 3-year mortality was 45.2% in the DD group compared with 20.0% in the ID/II group (P < 0.05). CONCLUSIONS: The DD genotype of the ACE gene polymorphism is associated with a more rapid decline in renal function and higher mortality in type 2 diabetic patients with established nephropathy.     

吉林地区汉族人ACE基因多态性与2型糖尿病合并冠心病的相关性研究

目的 探讨血管紧张素Ⅰ转换酶(ACE)基因插入/缺失(Ⅰ/D)多态性与吉林地区汉族人2型糖尿病患者合并冠心病的关系.方法 对80例2型糖尿病合并冠心病的患者,60例单纯2型糖尿病患者,60名健康人进行分组对照性研究.抽提人外周血中白细胞的基因组DNA,采用聚合酶链反应(PCR)扩增ACE基因第16内含子的一个287bpAlu的插入/缺失(I/D)基因片段,然后进行1.5%的琼脂糖凝胶电泳,并在紫外线灯下观察荧光带并确认每例的基因型.各组间的基因型频率比较应用Hardy-Weinburg遗传平衡定律检验和χ2检验.等位基因频率比较应用χ2检验.结果 各组间ACE基因的基因型频率分布有显著性差异(P＜0.05),等位基因频率分布无明显差异(P＜0.05).结论 ACE基因的I/D多态性与吉林地区汉族人2型糖尿病合并冠心病的发病无显著相关性.     

维生素D受体基因多态性与2型糖尿病发病的关联

目的:比较南京地区汉族人群中2型糖尿病患者与健康者之间维生素D受体基因限制性内切酶BsmⅠ位点等位基因频率和基因型频率分布的差异,分析维生素D受体基因多态性与2型糖尿病的关系。方法:①选择2001-09/2003-03南京医科大学第二附属医院内分泌科门诊就诊的2型糖尿病患者106例为糖尿病组,男45例,女61例。均符合1999年世界卫生组织糖尿病诊断标准。选择同期本院健康体检者102人为对照组,男42人,女60人。纳入对象均对实验目的知情同意。②采用聚合酶链反应-限制性片段长度多态性分析方法检测两组对象维生素D受体基因限制性内切酶BsmⅠ位点等位基因和基因型。计算维生素D受体基因等位基因频率和基因型频率,计量资料的比较用t检验,等位基因频率和基因型频率分布比较采用χ2检验。采用多因素非条件Logistic回归分析对维生素D受体基因BsmⅠ位点多态性与2型糖尿病的关系。结果:糖尿病患者106例和健康体检者102人均进入结果分析。①南京地区汉族人群中维生素D受体基因BsmⅠ酶切位点有2种等位基因B,b;存在3种基因型BB,Bb,bb。②维生素D受体基因BsmⅠ位点等位基因b,B频率在糖尿病组和对照组中的分布差异明显[糖尿病:39.6%,60.4%;对照组19.6%,80.4%,χ2=19.90,P<0.01],两组间基因型bb,Bb,BB的分布差异明显[糖尿病:17.9%,43.4%,38.7%;对照组5.9%,27.4%,66.7%,χ2=17.76,P<0.01]。等位基因b与2型糖尿病患病有显著关联(RR=2.7,P<0.05)。③多因素非条件Logistic回归分析结果显示,等位基因b是2型糖尿病的易感基因(P=0.01,OR=2.218,OR95%CI:1.99～3.778),而等位基因B对2型糖尿病具有保护作用(P=0.049,OR=0.359,OR95%CI:0.129～0.999)。结论:南京地区汉族人群中维生素D受体基因BsmⅠ位点多态性与2型糖尿病相关联,等位基因b可能是2型糖尿病的易感基因。     

Increased intracranial arterial resistance in patients with type 2 diabetes mellitus.

BACKGROUND: The majority of the studies investigating risk factors for stroke have focused on the atherosclerosis of extracranial carotid arteries. Risk factors for the involvement of intracranial arteries in patients with stroke have not been widely investigated so far. The pulsatility index reflects the vascular resistance of intracranial arteries and could therefore be used as an estimate of the severity of vascular damage. MAIN PURPOSE: The present study aimed to examine the influence of type 2 diabetes mellitus and some other atherosclerosis risk factors on intracranial vascular resistance in patients with a previous stroke or transient ischemic attack. METHODS: Transcranial doppler investigations were performed in 103 patients with previous stroke (31 with diagnosis of type 2 diabetes, 72 without diabetes), at least 3 months after stroke occurred. Blood flow velocities of anterior cerebral arteries, middle cerebral arteries, the intracranial part of vertebral arteries and the basilar artery, as well as of the extracranial part of the internal carotid artery were measured, and Gosling's pulsatility index was calculated. The maximal pulsatility index of intracranial arteries was defined to express the most pronounced damage. RESULTS: Diabetic patients had a significantly higher pulsatility index than non-diabetic patients in all examined intracranial arteries. The maximal pulsatility index was also significantly higher in diabetic patients than in non-diabetic patients (1.24 +/- 0.25 vs. 1.00 +/- 0.23; p < 0.0001). There was no significant difference in the pulsatility index between men and women and between groups of patients with or without hypertension. In the multivariate analysis, the presence of diabetes (p < 0.0001) and the age of patients (p < 0.0001) were the only factors significantly predicting maximal pulsatility index, and this relationship was independent on the presence of hypertension. CONCLUSIONS: Diabetic patients with previous stroke have a higher pulsatility index than non-diabetic patients with previous strokes, which indicates a higher increase in intracranial arterial resistance and more severe damage to cerebral blood flow in diabetes mellitus.     

Lipoprotein (a) as a determinant of arterial stiffness in elderly patients with type 2 diabetes mellitus

BACKGROUND: Lipoprotein (a) [Lp(a)] is known to be a risk factor for atherosclerotic disease. However, the relationship between Lp(a) and arterial stiffness has not been clarified. We investigated whether atherosclerotic risk factors, including serum Lp(a), are associated with aortic stiffness in elderly patients with type 2 diabetes mellitus. METHODS: Aortic stiffness, evaluated by using aortic pulse wave velocity, and major atherosclerotic risk factors were measured in elderly (> or =65 years) patients with type 2 diabetes mellitus. Relationships between aortic pulse wave velocity, Lp(a) and other atherosclerotic risk factors were analyzed. RESULTS: Among the atherosclerotic risk factors measured, age, pulse pressure, hemoglobin A1c (HbA1c), uric acid, fibrinogen, sialic acid and Lp(a) showed significant positive correlations with aortic pulse wave velocity. Lp(a) also showed significant positive correlations with pulse pressure, fibrinogen, sialic acid, apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio. The correlation between Lp(a) and aortic pulse wave velocity was independent of age, sex, blood hemoglobin A1c, uric acid and fibrinogen, history of diabetic nephropathy and therapy with lipid-lowering drugs. Apolipoprotein A-II showed a significant negative correlation with both aortic pulse wave velocity and Lp(a). The median level of Lp(a) in the highest tertile group of subjects divided by aortic pulse wave velocity was significantly higher than the median Lp(a) level in the lowest tertile. The middle and highest tertile groups of subjects divided by aortic pulse wave velocity showed significantly high odds ratios of high Lp(a) levels (> or =30 mg/dl) vs the lowest tertile. CONCLUSIONS: Lp(a) is an independent determinant of aortic stiffness in elderly patients with type 2 diabetes mellitus.     

骨形成蛋白-4基因多态性与绝经后妇女2型糖尿病伴骨质疏松症的相关性研究

目的探讨上海地区绝经后2型糖尿病(T2DM)和骨质疏松症(OP)妇女的骨形成蛋白-4(BMP-4)基因多态性的分布及其与骨密度(BMD)、骨代谢、糖代谢的关系。方法选取上海地区无亲缘关系的绝经后汉族妇女485例,其中OP组(A组)120例、T2DM组(B组)108例、T2DM合并OP组(C组)130例、健康老年对照组(D组)127例。检测股骨颈、L2～4 BMD、血清骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)、血浆糖化血红蛋白(HbA1c)和空腹血浆葡萄糖(FPG)。检测BMP-4基因多态性,比较各个临床指标与BMP-4基因型的相关性。结果在A组和C组中,股骨颈BMD、L2～4 BMD hh型低于HH型,差异有统计学意义(P值均为0.000),经年龄、绝经年限、BMI校正后比较仍有统计学意义(P值均为0.000),hh型低于Hh型,差异有统计学意义(P值均为0.000),经年龄、绝经年限、BMI校正后比较仍有统计学意义(P值均为0.000),HH型与Hh型相比无统计学意义(P>0.05),经年龄、绝经年限、BMI校正后比较仍无统计学意义(P>0.05)。结论在上海地区绝经后汉族女性OP患者中,BMP-4基因型h等位基因纯合子可能与低骨量有关。     

ACE gene polymorphism and proliferative retinopathy in type 1 diabetes: results of a case-control study.

OBJECTIVE: To evaluate the relationship between the ACE insertion/deletion polymorphism and proliferative diabetic retinopathy in patients with type 1 diabetes of long duration. Based on epidemiological and pathophysiological findings, risk factors apart from glycemic control and duration of disease are likely to be involved in the development of proliferative retinopathy. RESEARCH DESIGN AND METHODS: In this case-control study, we compared 81 patients with longstanding (> or =20 years) type 1 diabetes who had nonproliferative (mild or moderate background) retinopathy with 95 patients with diabetes of similar duration and HbA1c who had proliferative retinopathy. To avoid the confounding effect of nephropathy, patients with overt nephropathy were excluded, and microalbuminuria was introduced into the multiple logistical regression model. The polymorphic region in intron 16 of the ACE gene (17q23) was analyzed using the polymerase chain reaction. RESULTS: The ACE genotype distribution in patients with proliferative retinopathy (DD 39.4%, ID 48.9%, II 11.7%) was significantly different (P < 0.001) from that of patients with nonproliferative retinopathy (DD 17.3%, ID 54.3%, II 28.4%). In a multiple logistical regression analysis, the adjusted relative risk for proliferative retinopathy in a patient with a DD genotype compared with a patient with an II genotype was 6.6 (95% CI 2.2-19.5), P = 0.0026. In addition to genotype, systolic blood pressure (odds ratio 1.027 [95% CI 1.0-1.1], P = 0.0093) but not microalbuminuria (< or =20 vs. > or =20 microg/min) reached statistical significance in the multiple regression model. Because subjects were matched regarding diabetes duration and HbA1c, we did not interpret the respective parameter estimates. CONCLUSIONS: These data provide evidence that deletion in the ACE gene is associated with the prevalence of proliferative retinopathy in type 1 diabetes and suggest that the DD genotype confers susceptibility to proliferative retinopathy independent of diabetic nephropathy     

血液透析患者跟骨骨量减少与大动脉僵硬的关系

目的本研究旨在探讨血液透析患者低骨量与大动脉僵硬的关系。方法选择首都医科大学附属朝阳医院血液净化中心维持性血液透析患者41例。应用跟骨超声骨密度测定仪进行跟骨密度测定,同时测量颈总动脉僵硬度:采用日本Aloka Prosound α 10型彩色多普勒超声诊断仪,高分辨血管探头(频率7.5～13MHz),Echo-tracking技术(血管壁回声跟踪技术)测量颈总动脉僵硬度,以颈总动脉硬化参数β表示。β=[In(Ps/Pd)]/[(Ds-Dd)/Dd](Ds:血管收缩期内径,Dd:血管舒张期内径,Ps:收缩压,Pd:舒张压)。同时测定血清25-羟维生素D3、钙、磷、全段甲状旁腺素(intact parathyroid hormone,iPTH),C-反应蛋白、白蛋白、血脂水平。结果患者平均(57.0±12.3)岁。跟骨密度为(-2.1±0.8),14.6%的患者存在骨质疏松,58.5%的患者存在骨量减少;Pearson相关分析显示颈总动脉硬化参数β与跟骨密度呈负相关(r=-0.453,P=0.002);与血25-羟维生素D3呈负相关(r=-0.337,P=0.031);与血磷呈正相关(r=0.391,P=0.022);与平均动脉压呈正相关(r=0.298,P=0.043);与年龄呈正相关(r=0.477,P=0.002);而与校正后血钙、iPTH、C-反应蛋白、白蛋白、血脂水平无相关性。多元逐步回归分析显示,年龄(β=0.311,P=0.008)、跟骨密度(β=-0.218,P=0.043)是颈总动脉硬化参数β的独立影响因素。跟骨密度与25-羟维生素D3呈正相关(r=0.315,P=0.049);与年龄呈负相关(r=-0.381,P=0.014);与血磷呈负相关(r=-0.323,P=0.046),而与校正后血钙、iPTH无相关性。结论血液透析患者普遍存在低骨量,而低骨量与大动脉僵硬度增加独立相关。     

2型糖尿病患者动态动脉僵硬指数和24h脉压的相关性研究

目的:探讨2型糖尿病患者动态动脉僵硬指数(AASI)与24 h脉压(24hPP)的相关关系.方法:入选2型糖尿病患者共100例,按照是否合并高血压分为:非合并高血压组(n=32例)和合并高血压组(68例).记录患者临床情况,包括性别、年龄、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1C)和尿微量白蛋白与肌酐的比值(ACR),记录患者24 h动态血压参数,包括24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、24h脉压(24hPP)、夜间平均收缩压/白昼平均收缩压比值(nSBP/dSBP)、夜间平均舒张压/白昼平均舒张压比值(nDBP/dDBP).然后按AASI=1-舒张压对收缩压的回归斜率计算每个个体的AASI值.结果:两组患者在ACR、24hSBP、24hDBP、24hPP和AASI差异有显著性(均P＜0.05).AASI与年龄、ACR、24hPP、nSBP/dSBP和nDBP/dDBP有显著性相关性(均P＜ 0.05).结论:糖尿病患者,无论是否合并存在高血压,AASI均与24 h脉压存在密切的相关性,可以反映动脉的僵硬度.     

脂蛋白脂酶HindⅢ酶切多态性与2型糖尿病患者血脂及冠心病的关系

目的:观察天津市汉族人群脂蛋白脂酶基因内含子8第495位点多态性分布情况,探讨基因分布与2型糖尿病的关联性。方法:选择2004-01/06在天津医科大学总医院内分泌科住院及门诊部收治的104例2型糖尿病组患者为糖尿病组,均符合1997年美国糖尿病学会诊断标准确,男70例,女34例,平均(50±5)岁,其中合并冠心病患者18例,均符合国际冠心病诊断标准。选择94名同期到院体检者为对照组,男62名,女32名,平均(49±6)岁,空腹血糖<6.1mmol/L。葡萄糖氧化酶─过氧化物酶法检测所有受试对象血浆葡萄糖含量,CHOD-PAP法检测所有受试对象血清胆固醇水平,GPO-PAP法检测血清三酰甘油水平,放射免疫法检测血清胰岛素。用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)法测定脂蛋白脂酶基因内含子8第495位点多态性。根据本实验设计的引物,若2条同源染色体上该位点都为T,表示为TT;若该位点均为G,表示为GG;若两条同源染色体上该位点分别是T和G,表示为TG。结果:①糖尿病组及对照组受试对象内含子8第495位点多态性基因型或等位基因频率差异均无统计学意义。②TT组糖尿病患者三酰甘油水平显著高于TG/GG组(2.14±1.45,1.55±0.96mmol/L,P<0.05)。③糖尿病组冠心病及非冠心病患者TT和TG/GG基因型无明显差别。④多元回归分析表明基因型、年龄、胰岛素抵抗与2型糖尿病合并高三酰甘油有关。⑤将糖尿病患者根据三酰甘油>1.7mmol/L定为高三酰甘油组,三酰甘油≤1.7mmol/L定为低三酰甘油组。在2型糖尿病组TT基因型和T等位基因与高三酰甘油有关,对照组没有统计学差异。结论:天津市汉族人群存在脂蛋白脂酶基因内含子8第495位点单核苷酸多态性。脂蛋白脂酶基因内含子8第495位点多态性与2型糖尿病无关。脂蛋白脂酶基因内含子8第495位点多态性与2型糖尿病合并高三酰甘油存在关联性,T等位基因是2型糖尿病合并高三酰甘油的独立危险因素。     

血管紧张素转换酶缺失等位基因与IgA肾病预后的关系

目的探讨ACE基因插入/缺失多态性与IgA肾病发生发展的关联。方法利用一对侧翼引物及一对序列特异性引物和多聚酶链反应(PCR)技术,对ACE基因多态性及其与IgA肾病的关联进行相关分析。结果肾活检时血清肌酐升高的IgA肾病患者DD基因型频率明显增高(P<0.05);而Ⅱ基因型频率在轻度肾小球病变组明显增高(P<0.05)。结论ACE-DD基因型与肾活检时肾功能减退有关,而Ⅱ基因型与轻度肾小球病变有关。提示ACE-D等位基因可能是IgA肾病预后不良的遗传标志。     

C-反应蛋白-717 A>G多态性与2型糖尿病的相关性

目的研究C-反应蛋白-717A〉G多态性与河北唐山地区人群2型糖尿病（T2DM）的相关性。方法应用PCR-RFLP方法对127名T2DM患者和155名健康对照者（NC）行CRP-717A〉G基因型检测，并测身高、体重、血脂、FPG、HbA1c和11s—CRP。结果两组间GA＋CG基因型及G等位基因频率差异无统计学意义（P〉0．05）。从基因型个体甘油三脂水平显著高于GA＋GG型个体（P=0．014），但这种关系只限于T2DM患者。结论CRP-717A〉G基因多态性与该人群T2DM无相关性。该基因型与T2DM患者甘油三脂水平有关，可能影响糖尿病患者的脂代谢过程。     

糖尿病患者维生素D受体基因多态性与骨质疏松的相关性

目的:观察糖尿病患者与正常人之间以及不同骨量的糖尿病患者之间维生素D受体基因型的分布差异。方法:选自青岛市内分泌糖尿病研究所内分泌科1998-09/2001-01住院糖尿病患者122例为糖尿病组,诊断参照WHO1999年新标准,并且除外重度吸烟、嗜酒者、肾功能损害者及服用影响骨代谢药物者。2型糖尿病组68例,1型糖尿病组54例。以中国骨质疏松症建议诊断标准为依据诊断骨质疏松和骨量减少。糖尿病组骨量正常58例(男/女=33/25),骨量减少30例(男/女=15/15),骨质疏松34例(男/女=17/17)。并以青岛市内分泌糖尿病研究所62名体检健康成年人为对照组,采用聚合酶链反应限制性片段长度多态性技术对其进行维生素D受体,基因(A-paI,TaqI位点)型检测,并计算其基因分布频率。结果:①1型糖尿病组、2型糖尿病组与健康人维生素D受体基因型分布频率的比较1型糖尿病组Tt基因型的分布频率有增高趋势(1型糖尿病组14.8%,2型糖尿病组7.4%,对照组4.8%,P=0.068)。②维生素D受体基因多态性与糖尿病性骨质疏松的相关性:在糖尿病患者群中,aa基因型在骨量减少和骨质疏松患者中分布频率显著高于糖尿病骨量正常者(骨量减少组63.3%,骨质疏松组73.5%,骨量正常组41.3%,P<0.05),Aa基因型分布频率显著低于骨量正常者(骨量减少组26.7%,骨质疏松组26.5%,骨量正常组44.8%,P<0.05),糖尿病骨质疏松患者中未检出AA基因型。结论:在糖尿患者群中,维生素D受体基因分布与健康人差异不显著。糖尿病患者对应于ApaI酶切位点的维生素D受体基因多态与骨质疏松存在相关性,对应于TaqI酶切位点的维生素D受体基因多态与1型糖尿病的发生有相关趋势,对糖尿病骨质疏松的发生有一定的预测价值。     

白细胞介素-18基因-607C/A多态性与2型糖尿病的相关性

目的研究白细胞介素-18（interleukin 18,IL-18）基因单核苷酸多态性与河北唐山地区人群2型糖尿病（T2DM）的相关性。方法应用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法对122名T2DM患者和161名健康对照者（NC）行IL-18启动子-607C/A基因型检测,并测定血清hs-CRP。结果糖尿病与对照组比较,IL-18基因-607C/A多态性分布差异有统计学意义（P〈0.05）,C等位基因携带者患T2DM的风险是A等位基因的1.883倍（OR=1.883,95%CI：1.28-2.771）。两组人群中CC和CA基因型个体CRP浓度均显著高于AA基因型个体（P〈0.05）。结论IL-18基因-607C/A多态性与T2DM的发病具有相关性,其中C等位基因可能是T2DM的遗传易感基因,并导致血清CRP浓度升高。     

The influence of adiponectin gene polymorphism on the rosiglitazone response in patients with type 2 diabetes

OBJECTIVE: The aim of this study was to examine the effects of rosiglitazone on adiponectin and plasma glucose levels in relation with common adiponectin gene (ACDC) polymorphisms. RESEARCH DESIGN AND METHODS: A total of 166 patients with type 2 diabetes were treated with rosiglitazone (4 mg/day) for 12 weeks without changing any of their previous medications. In all, single nucleotide polymorphism (SNP)45 and SNP276 of ACDC were examined. RESULTS: Regarding SNP45, there was a smaller reduction in the fasting plasma glucose (FPG) level and the HbA(1c) value in the carriers of the GG genotype than in the carriers of the other genotypes (P = 0.031 and 0.013, respectively). There was a smaller increase in the serum adiponectin concentration for the GG genotype than for the other genotypes (P = 0.003). Regarding SNP276, there was less reduction in the FPG level for the GG genotype than for the other genotypes (P = 0.001). In the haplotype analysis, the reductions in the FPG and HbA(1c) levels were smaller for the GG homozygote haplotype than for the other haplotypes (P = 0.001 and 0.001, respectively). The increase in the plasma adiponectin concentration for the GG homozygote haplotype was smaller than that of the other haplotypes (P = 0.003). CONCLUSIONS: These data suggest that genetic variations in the adiponectin gene can affect the rosiglitazone treatment response of the circulating adiponectin level and blood glucose control in type 2 diabetic patients.     

Radial artery tonometry demonstrates arterial stiffness in children with type 1 diabetes

OBJECTIVE: To determine if children with type 1 diabetes have increased arterial stiffness by estimating augmentation index with the simple noninvasive technique of radial artery tonometry. RESEARCH DESIGN AND METHODS: We studied 98 type 1 diabetic children and 57 healthy control subjects, ages 10-18 years, matched for age, sex, race, and BMI, generating 43 matched pairs. Radial artery tonometry was performed, and blood was collected for analysis of fasting lipids, HbA1c, glucose, and cytokines in all children. RESULTS: Children with diabetes had a significantly higher augmentation index corrected to a heart rate of 75 (AI75) than their matched control subjects. Mean AI75 in type 1 diabetic subjects was 1.11 +/- 10.15 versus -3.32 +/- 10.36 in control subjects. The case-control difference was 5.20 +/- 11.02 (P=0.0031). CONCLUSIONS: Children with type 1 diabetes have increased arterial stiffness compared with healthy control subjects. Radial artery tonometry is a simple noninvasive technique that could be added to the armamentarium of tests used to provide cardiovascular risk stratification in children with type 1 diabetes.     

Cerebral perfusion in patients with arterial hypertension associated with type 2 diabetes

The aim of the study was to assess cerebral perfusion (CP) in patients with arterial hypertension in combination with type II diabetes. The subjects were 57 patients with stage II AH (mean age 51.6 +/- 5.7 years), among who there were 33 patients without disturbances in carbohydrate exchange and 24 patients with compensated or subcompensated type II diabetes. All the patients underwent single-photon emission computed tomography of the brain with 99m Tchexamethylpropyleneamineoxime. The study showed that patients suffering from AH with or without type II diabetes had signs of cerebral hypoperfusion and lowered cerebrovascular reserve even in the absence of focal neurological symptoms. Disturbances in cerebral perfusion were more prominent in patients suffering from AH with type II diabetes vs. patients without carbohydrate exchange disorder.     

Reduced mortality associated with the use of ACE inhibitors in patients with type 2 diabetes

OBJECTIVE: ACE inhibitor therapy is widely used in lower-risk patients with type 2 diabetes to reduce mortality, despite limited evidence to support this clinical strategy. The aim of this study was to evaluate the association between ACE inhibitor use and mortality in patients with diabetes and no cardiovascular disease. RESEARCH DESIGN AND SETTINGS: Using the Saskatchewan health databases, 12,272 new users of oral hypoglycemic agents were identified between the years of 1991 and 1996. We excluded 3,202 subjects with previous cardiovascular disease. Of the remaining subjects, 1,187 "new users" of ACE inhibitors were identified (ACE inhibitor cohort). Subjects not receiving ACE inhibitor therapy throughout the follow-up period served as the control cohort (n = 4,989). Subjects were prospectively followed until death or the end of 1999. Multivariate Cox proportional hazards models were used to assess differences in all-cause and cardiovascular-related mortality between cohort groups. RESULTS: Subjects were 60.7 +/- 13.7 years old, 43.6% female, and were followed for an average of 5.3 +/- 2.1 years. Mean duration of ACE inhibitor therapy was 3.6 +/- 1.8 years. We observed significantly fewer deaths in the ACE inhibitor group (102 [8.6%]) compared with the control cohort (853 [17.1%]), with an adjusted hazard ratio (HR) and 95% CI of 0.49 (0.40-0.61) (P < 0.001). Cardiovascular-related mortality was also reduced (40 [3.4%] vs. 261 [5.2%], adjusted HR, 0.63 [0.44-0.90]; P = 0.012). CONCLUSIONS: The use of ACE inhibitors was associated with a significant reduction in all-cause and cardiovascular-related mortality in a broad spectrum of patients with type 2 diabetes and no cardiovascular disease.