Pulse wave reflection is associated with diabetes duration,albuminuria and cardiovascular disease in type 1 diabetes

Aims

We investigate associations between the pulse-wave-derived measures augmentation pressure (AP) and augmentation index, and diabetic complications in type 1 diabetes.

Methods

This cross-sectional study from 2009–2011 included 676 type 1 diabetes patients. SphygmoCor (Atcor Medical, Australia) measured AP and heart rate-adjusted augmentation index (AI75). Diabetic complications were micro- or macroalbuminuria urinary albumin excretion rate (UAER) 30–299 or ≥300 mg/24-h], cardiovascular disease (CVD) (previous revascularization, myocardial infarction, peripheral arterial disease or stroke), autonomic dysfunction (heart rate variability <11 beats/min), or retinopathy (simple, proliferative or blindness). Adjustments included age, gender, diabetes duration, mean arterial pressure, heart rate, height, UAER, eGFR, HbA_1c, total cholesterol, total daily insulin dose, antihypertensive medication, and smoking.

Results

AP and AI75 measurements were available in 636 (94.1 %) patients and were 9.9 ± 7.6 mmHg and 16.9 ± 12.0, respectively. After adjustment, AP and AI75 were independently associated with diabetes duration and albuminuria (p ≤ 0.001). Furthermore, higher AP and AI75 were associated with previous CVD adjusted odds ratios (95 % confidence interval) (per 1 SD increase) 1.9 (1.3–2.7) and 1.5 (1.0–2.2) (p ≤ 0.039)], but not with autonomic dysfunction or retinopathy (p ≥ 0.12).

Conclusions

In type 1 diabetes, augmentation pressure and heart rate-adjusted augmentation index were associated with diabetes duration, albuminuria, and CVD, independently of conventional risk factors. ClinicalTrials.gov:NCT01171248.