A short-term admission improved brachial–ankle pulse wave velocity in type 2 diabetic patients

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Abstract

Brachial–ankle pulse wave velocity (baPWV) is a non-invasive method for assessing arterial stiffness associated with atherosclerosis. We examined whether baPWV could improve during a 2-week hospital-based education program in patients with type 2 diabetes and whether improvement associates with changes in known atherogenic risk factors. Body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), insulin, lipid profiles and baPWV were measured in 32 type 2 diabetic patients before and after an educational program that included advice about nutrition and exercise. Relationship between the changes in baPWV and additional parameters, 24 h-urinary excretion of C-peptide, visceral and subcutaneous fat area by abdominal computer tomography and intima-medial thickness (IMT) of the carotid artery by ultrasonography, were also evaluated. Baseline values of baPWV significantly correlated with age, duration of diabetes, BP, IMT and FPG. BaPWV significantly decreased after the program (−120 ± 108.4 cm/s, P < 0.0001) and this change significantly correlated with that of systolic BP (r = 0.697, P < 0.0001) and FPG (r = 0.452, P < 0.05). These results indicate that short-term hospitalization with an educational program can improve arterial wall stiffness, perhaps due to improvements in BP and glycemic control.

Introduction

Aortic pulse wave velocity (PWV) is a non-invasive method for assessing arterial stiffness associated with atherosclerosis, which is known to be accelerated in diabetes and to result in increased risk of cardiovascular events and diabetic renal failure [1], [2]. PWV also has been reported to associate with all-cause and cardiovascular mortality, independent of previous cardiovascular diseases, age and diabetes [3], [4], [5], [6], [7], [8]. Therefore, the clinical relevance of PWV measurement is becoming increasingly significant. Although correcting hypertension, hyperlipidemia and other metabolic markers by using drugs and/or diet have been reported to improve arterial wall stiffness in patients and healthy volunteers [9], [10], [11], [12], [13], this improvement takes several months to become apparent. In our hospital, we have a 2-week educational admission program for type 2 diabetic patients, in which patients usually improve their metabolic parameters. Therefore, we examined, using a recently developed brachial–ankle pulse wave velocity (baPWV) device, whether a short-term intervention with diet and exercise could improve arterial wall stiffness in diabetic patients and whether changes in known atherogenic markers associate with this improvement.

Section snippets

Research design and methods

The study was performed at the Japan Self Defense Forces Central Hospital (Setagaya, Tokyo, Japan). Exclusion criteria for the study included fasting plasma glucose >180 mg/dl, history of myocardial infarction, cerebral infarction, or peripheral vascular disease, insulin use, any apparent retinopathy, nephropathy and neuropathy. The Hospital Ethical Review Committee approved all procedures and protocols, and written informed consent was obtained from all subjects before enrollment. Thirty-two

Results

Baseline values of baPWV correlated significantly with age (r = 0.423, P < 0.05), duration of diabetes (r = 0.425, P < 0.05), SBP (r = 0.580, P = 0.0005), DBP (r = 0.514, P = 0.0026), mean BP (r = 0.584, P = 0.0004), IMT (r = 0.507, P < 0.005) and FPG (r = 0.355, P < 0.05). Stepwise regression analysis showed significant correlations between baPWV and duration of diabetes, mean BP or FPG (Table 2).

After the program, baPWV significantly decreased (−120 ± 108.4 cm/s, P < 0.0001) along with significant decreases in BP, FPG, BW,

Discussion

The baseline values of baPWV correlated significantly with BP, age, FPG, duration of diabetes and IMT at admission, as shown in previous studies using carotid-femoral PWV [4], [15], [16], [17], [18], [19]. This confirms the usefulness of the apparatus, Form ABI/PWV, as previously described [20], [21]. BP is a factor that strongly influences PWV and arterial stiffness directly correlates with vascular resistance, and is one of the two basic factors that determine BP. Nevertheless, PWV can result

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