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Clinical Trial
. 2021 Jul 30;16(7):e0254859.
doi: 10.1371/journal.pone.0254859. eCollection 2021.

Endothelial glycocalyx and cardio-renal risk factors in type 1 diabetes

Elisabeth Buur Stougaard  1 , Signe Abitz Winther  1 , Hanan Amadid  2 , Marie Frimodt-Møller  1 , Frederik Persson  1 , Tine Willum Hansen  1 , Peter Rossing  1   3
Affiliations
Clinical Trial

Endothelial glycocalyx and cardio-renal risk factors in type 1 diabetes

Elisabeth Buur Stougaard et al. PLoS One. .

Abstract

Background: Glycocalyx lines the inner surface of the capillary endothelium. Capillaroscopy enables visualization of the sublingual capillaries and measurement of the Perfused Boundary Region (PBR) as an estimate of the glycocalyx. Novel software enables assessment of the PBR estimated at a fixed high flow level (PBR-hf) and an overall microvascular assessment by the MicroVascular Health Score (MVHS). Damaged glycocalyx may represent microvascular damage in diabetes and assessment of its dimension might improve early cardio-renal risk stratification.

Aim: To assess the associations between PBR, PBR-hf and MVHS and cardio-renal risk factors in persons with type 1 diabetes (T1D); and to compare these dimensions in persons with T1D and controls.

Methods: Cross-sectional study including 161 persons with T1D stratified according to level of albuminuria and 50 healthy controls. The PBR, PBR-hf and MVHS were assessed by the GlycoCheck device (valid measurements were available in 136 (84.5%) with T1D and in all the controls). Higher PBR and PBR-hf indicate smaller glycocalyx width. Lower MVHS represents a worse microvascular health.

Results: There were no associations between PBR, PBR-hf or MVHS and the cardio-renal risk factors in persons with T1D, except for higher PBR-hf and lower MVHS in females (p = 0.01 for both). There was no difference in PBR, PBR-hf or MVHS in persons with normo-, micro- or macroalbuminuria. The PBR was higher (2.20±0.30 vs. 2.03±0.18μm; p<0.001) and MVHS lower (3.15±1.25 vs. 3.53±0.86μm; p = 0.02) in persons with T1D compared to controls (p≤0.02). After adjustment for cardio-renal risk factors the difference in PBR remained significant (p = 0.001).

Conclusions: The endothelial glycocalyx dimension was impaired in persons with T1D compared to controls. We found no association between the endothelial glycocalyx dimension and the level of albuminuria or cardio-renal risk factors among persons with T1D. The use of the GlycoCheck device in T1D may not contribute to cardio-renal risk stratification.

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Conflict of interest statement

I have read the journal´s policy and the authors of this manuscript have the following competing interests: [Peter Rossing (PR) has received research grants from AstraZeneca and Novo Nordisk. He has received lecture and/or consultancy fees (to his institution) from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Gilead, Merck, Mundipharma, Novo Nordisk and Sanofi Aventis. Frederik Persson (FP) reports having received research grants from AstraZeneca, Novo Nordisk and Novartis and lecture fees from Novartis, Eli Lilly, MSD, AstraZeneca, Sanofi, Novo Nordisk and Boehringer Ingelheim and having served as a consultant for Astra Zeneca, Bayer, Amgen, Novo Nordisk and MSD]. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Schematic representation of the Perfused Boundary Region (PBR) [6].
Fig 2
Fig 2. Glycocalyx measurements within the group of healthy controls and type 1 diabetes.
Perfused Boundary Region (p<0.001), Perfused Boundary Region-high flow (p = 0.13) and MicroVascular Health Score (p = 0.02). P-values are for the unadjusted analyses.
Fig 3
Fig 3. Glycocalyx measurements in participants with type 1 diabetes and normo-, micro- and macroalbuminuria.
Perfused Boundary Region (p = 0.83), Perfused Boundary Region- high flow (p = 0.41) and MicroVascular Health Score (p = 0.34). P-values are for the unadjusted analyses.
Fig 4
Fig 4. Glycocalyx measurements in participants divided into groups according to eGFR level.
Perfused Boundary Region (p = 0.86), Perfused Boundary Region-high flow (p = 0.53) and MicroVascular Health Score (p = 0.999). P-values are for the unadjusted analyses.
See this image and copyright information in PMC

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