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1.
Diab Vasc Dis Res ; 14(3): 191-199, 2017 05.
Article in English | MEDLINE | ID: mdl-28467200

ABSTRACT

BACKGROUND: The development of disturbances in skin microcirculation in type 1 diabetes is not well characterised. We assessed skin microcirculation longitudinally from the onset of diabetes up to 29 years of duration to investigate when such disturbances start. MATERIAL AND METHODS: Seventeen adult patients with type 1 diabetes participated. Skin microvascular function in digit IV of the left hand was investigated by laser Doppler fluxmetry (LDF, arbitrary units [AU]). LDF was carried out at rest and following one-min arterial occlusion. Time to peak LDF (s) and percentage increase of LDF (post-occlusive reactive hyperaemia, PRH%) were determined. Retinopathy was assessed from fundus photographs or ophthalmoscopic recordings. RESULTS: Skin microvascular function remained normal during the first five years. Compared with baseline and a non-diabetic reference group, time to peak LDF was prolonged after 7-9 years of diabetes ( p < 0.01). PRH% was lower than in the reference group after 7-9 years ( p < 0.01), and lower than baseline after 24-29 years of diabetes ( p < 0.05). All but one patient developed retinopathy and the first signs were found after 10 years of diabetes. CONCLUSIONS: Functional disturbances in total skin microcirculation were observed after seven years in patients with type 1 diabetes and preceded diabetic complications such as retinopathy.


Subject(s)
Diabetes Mellitus, Type 1/complications , Diabetic Angiopathies/etiology , Microcirculation , Microvessels/physiopathology , Skin/blood supply , Adult , Blood Flow Velocity , Case-Control Studies , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/physiopathology , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/physiopathology , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/etiology , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/etiology , Disease Progression , Female , Humans , Laser-Doppler Flowmetry , Longitudinal Studies , Male , Middle Aged , Ophthalmoscopy , Prospective Studies , Regional Blood Flow , Risk Factors , Skin Temperature , Time Factors , Young Adult
2.
Thromb Res ; 126(3): e225-31, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20637495

ABSTRACT

INTRODUCTION: Diabetes is a prothrombotic state involving a more thrombogenic fibrin network. In the present study we investigated the effects of lipid-lowering therapy with atorvastatin on fibrin network structure and platelet-derived microparticles in patients with type 1 diabetes and dyslipidemia. MATERIALS AND METHODS: Twenty patients were treated with atorvastatin (80 mg daily) or placebo during 2 months in a randomized, double-blind, cross-over study. Fibrin network permeability, expression of glycoprotein IIIa, P-selectin and tissue factor on platelet-derived microparticles, plasma endogenous thrombin potential, plasminogen activator inhibitor-1 and tissue plasminogen activator antigen levels were assessed. Additionally, levels of plasma fibrinogen, high-sensitivity C-reactive protein and glycated haemoglobin were measured. RESULTS: During treatment with atorvastatin, fibrin network permeability increased (p=0.01), while endogenous thrombin potential and expression of glycoprotein IIIa, P-selectin and tissue factor decreased (p<0.01). In vitro experiments indicated that platelet-derived microparticles influence the fibrin network formation as fibrin network permeability decreased significantly when platelet-derived microparticles were added to normal plasma. Baseline levels of plasminogen activator inhibitor-1 and tissue plasminogen activator antigen as well as plasma fibrinogen and high-sensitivity C-reactive protein were within reference values and not significantly changed during atorvastatin treatment, while glycated haemoglobin increased 0.3% (p<0.001). CONCLUSIONS: Novel treatment effects were found in patients with type 1 diabetes and dyslipidemia during atorvastatin therapy, i.e. a more porous fibrin network, to which reduced expression of glycoprotein IIIa, P-selectin and tissue factor on platelet-derived microparticles may contribute. The observed impairment of glycemic control during long-term statin treatment deserves attention.


Subject(s)
Diabetes Mellitus, Type 1/complications , Dyslipidemias/drug therapy , Fibrinolytic Agents/therapeutic use , Heptanoic Acids/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Pyrroles/therapeutic use , Thrombosis/drug therapy , Adult , Aged , Atorvastatin , Biomarkers/blood , Blood Platelets/drug effects , Blood Platelets/metabolism , C-Reactive Protein/metabolism , Cell-Derived Microparticles/drug effects , Cell-Derived Microparticles/metabolism , Cross-Over Studies , Diabetes Mellitus, Type 1/blood , Double-Blind Method , Dyslipidemias/blood , Dyslipidemias/complications , Fibrin/metabolism , Glycated Hemoglobin/metabolism , Humans , Integrin beta3/blood , Middle Aged , P-Selectin/blood , Plasminogen Activator Inhibitor 1/blood , Sweden , Thrombin/metabolism , Thromboplastin/metabolism , Thrombosis/blood , Thrombosis/etiology , Time Factors , Treatment Outcome
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