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Endothelial dysfunction may predict diabetic neuropathy
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Peripheral vascular dysfunction, as assessed by flow-mediated dilation, is associated with diabetic peripheral neuropathy, according to recent study findings.
In a cross-sectional analysis, Matthieu Roustit, PharmD, PhD, of Beth Israel Deaconess Medical Center in Boston, and colleagues analyzed data from 492 adults with prediabetes (n = 75), type 1 or type 2 diabetes with and without diabetic peripheral neuropathy (n = 358; 166 with neuropathy), and no diabetes (controls; n = 59) from different studies conducted at the microcirculatory lab at Beth Israel Deaconess Medical Center. Researchers assessed endothelial function via flow-mediated dilation and measured inflammatory cytokines; physical exams were quantified using the neuropathy disability score (NDS). Participants underwent sensory testing with the vibration perception threshold on the great toe. All procedures were standardized across the different studies.
In analyses to identify predictors of NDS (n = 318), researchers found that flow-mediated dilation, in addition to duration of diabetes, HbA1c, and traditional CV risk factors, was a “strong predictor” (P < .001).
“Sensitivity analysis removing [flow-mediated dilation] from the list of independent variables yielded to similar conclusions for [intercellular adhesion molecule 1], another biomarker of endothelial dysfunction, although the correlation was weaker,” the researchers wrote.
In confirmatory factor analysis (n = 280), researchers found that endothelial dysfunction — but not inflammation — mediated the effects of duration of diabetes and HbA1c on CV risk factors and diabetic peripheral neuropathy, explaining 68% of the variance of diabetic peripheral neuropathy.
“It suggests that endothelial dysfunction, assessed using [flow-mediated dilation] and [intercellular adhesion molecule 1], is a significant mediator between diabetes duration and HbA1c, and cardiovascular risk factors and [diabetic peripheral neuropathy],” the researchers wrote.
The researchers noted that the cross-sectional study design does not allow assessment of the direction of the relationship between endothelial dysfunction and diabetic peripheral neuropathy, but that results suggest it is likely that endothelial dysfunction occurs or is detected earlier than neuropathy.
“This study confirms that endothelial dysfunction occurs early in the pathophysiology of diabetes, and shows that [flow-mediated dilation] is a strong, independent predictor of peripheral diabetic neuropathy,” the researchers wrote. “It further suggests that endothelial dysfunction mediates the deleterious effects of diabetes on [CV] risk and [diabetic peripheral neuropathy].” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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