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Observational Study
. 2016 Jun 1;6(6):e010400.
doi: 10.1136/bmjopen-2015-010400.

Evolution of target organ damage and haemodynamic parameters over 4 years in patients with increased insulin resistance: the LOD-DIABETES prospective observational study

Manuel Ángel Gómez-Marcos  1 , José Ignacio Recio-Rodríguez  2 , María Carmen Patino-Alonso  3 , Cristina Agudo-Conde  2 , Emiliano Rodríguez-Sanchez  1 , Jose Angel Maderuelo-Fernandez  2 , Leticia Gómez-Sánchez  4 , Marta Gomez-Sanchez  4 , Luís García-Ortiz  5 ; LOD-DIABETES Group
Affiliations
Observational Study

Evolution of target organ damage and haemodynamic parameters over 4 years in patients with increased insulin resistance: the LOD-DIABETES prospective observational study

Manuel Ángel Gómez-Marcos et al. BMJ Open. .

Abstract

Objectives: We prospectively examined the impact of type 2 diabetes compared with metabolic syndrome (MetS) on the development of vascular disease over 4 years as determined by anatomic and functional markers of vascular disease. By comparing the vascular outcomes of the 2 disorders, we seek to determine the independent effect of elevated glucose levels on vascular disease.

Setting: 2 primary care centres in Salamanca, Spain.

Participants: We performed a prospective observational study involving 112 patients (68 with type 2 diabetes and 44 with MetS) who were followed for 4 years.

Primary and secondary outcome measures: Measurements included blood pressure, blood glucose, lipids, smoking, body mass index, waist circumference, Homeostasis Model Assessment Insulin Resistance (HOMA-IR), hs-c-reactive protein and fibrinogen levels. We also evaluated vascular, carotid intima media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index, heart and renal target organ damage (TOD). The haemodynamic parameters were central (CAIx) and peripheral (PAIx) augmentation indices.

Results: In year 4, participants with type 2 diabetes had increased IMT thickness. These patients had more plaques and an IMT>0.90 mm. In participants with MetS, we only found an increase in the number of plaques. We found no changes in PWV, CAIx and PAIx. The patients with diabetes had a greater frequency of vascular TOD. There were no differences neither in renal nor cardiac percentage of TOD in the patients with MetS or diabetes mellitus type 2.

Conclusions: This prospective study showed that the evolution of vascular TOD is different in participants with type 2 diabetes compared with those with MetS. While IMT and PWV increased in type 2 diabetes, these were not modified in MetS. The renal and cardiac TOD evolution, as well as the PAIx and CAIx, did not change in either group.

Trial registration number: NCT01065155; Results.

Keywords: Arterial stiffness; Drug treatment; Metabolic syndrome; Target organ damage; Type 2 diabetes mellitus.

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Figures

Figure 1
Figure 1
Study flow chart. The participants were analysed each year for cardiovascular events in each group. We include the evolution of patients with MetS to type 2 diabetes. CV, cerebrovascular; MetS, metabolic syndrome; DM, type 2 diabetes.
Figure 2
Figure 2
Changes between the 4 years of follow-up in TOD. (A) TOD in type 2 diabetes. (B) TOD in metabolic syndrome. In type 2 diabetes: p<0.01 in TOD overall, TOD vascular, carotid and cf-PWV. IMT, intima media thickness; cf-PWV, carotid femoral pulse wave velocity; ABI, ankle brachial index; GFR, glomerular filtration rate; ACR, albumin creatinine ratio; TOD, target organ damage.
Figure 3
Figure 3
Estimated unadjusted means (A and C), and adjusted by age, gender, atherogenic index and office blood pressure (B and D) of IMT and PWV in patients with type 2 diabetes and metabolic syndrome. IMT, intima media thickness; PWV, pulse wave velocity.
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