Type 2 diabetes is associated with an increased risk of endothelial dysfunction and microvascular complications with impaired autoregulation of tissue perfusion. Both microvascular disease and cardiovascular autonomic neuropathy may affect cerebral autoregulation. In the present study, we tested the hypothesis that, in the absence of cardiovascular autonomic neuropathy, cerebral autoregulation is impaired in subjects with DM+ (Type 2 diabetes with microvascular complications) but intact in subjects with DM− (Type 2 diabetes without microvascular complications). Dynamic cerebral autoregulation and the steady-state cerebrovascular response to postural change were studied in subjects with DM+ and DM−, in the absence of cardiovascular autonomic neuropathy, and in CTRL (healthy control) subjects. The relationship between spontaneous changes in MCA Vmean (middle cerebral artery mean blood velocity) and MAP (mean arterial pressure) was evaluated using frequency domain analysis. In the low-frequency region (0.07–0.15 Hz), the phase lead of the MAP-to-MCA Vmean transfer function was 52±10 ° in CTRL subjects, reduced in subjects with DM− (40±6 °; P<0.01 compared with CTRL subjects) and impaired in subjects with DM+ (30±5 °; P<0.01 compared with subjects with DM−), indicating less dampening of blood pressure oscillations by affected dynamic cerebral autoregulation. The steady-state response of MCA Vmean to postural change was comparable for all groups (−12±6% in CTRL subjects, −15±6% in subjects with DM− and −15±7% in subjects with DM+). HbA1c (glycated haemoglobin) and the duration of diabetes, but not blood pressure, were determinants of transfer function phase. In conclusion, dysfunction of dynamic cerebral autoregulation in subjects with Type 2 diabetes appears to be an early manifestation of microvascular disease prior to the clinical expression of diabetic nephropathy, retinopathy or cardiovascular autonomic neuropathy.
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October 2008
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Research Article|
September 12 2008
Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes
Yu-Sok Kim;
Yu-Sok Kim
*Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
†Human Cardiovascular Physiology Unit, AMC Center for Heart Failure Research, University of Amsterdam, Amsterdam, The Netherlands
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Rogier V. Immink;
Rogier V. Immink
†Human Cardiovascular Physiology Unit, AMC Center for Heart Failure Research, University of Amsterdam, Amsterdam, The Netherlands
‡Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Wim J. Stok;
Wim J. Stok
†Human Cardiovascular Physiology Unit, AMC Center for Heart Failure Research, University of Amsterdam, Amsterdam, The Netherlands
§Department of Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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John M. Karemaker;
John M. Karemaker
†Human Cardiovascular Physiology Unit, AMC Center for Heart Failure Research, University of Amsterdam, Amsterdam, The Netherlands
§Department of Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Niels H. Secher;
Niels H. Secher
∥Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
¶The Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Johannes J. van Lieshout
*Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
†Human Cardiovascular Physiology Unit, AMC Center for Heart Failure Research, University of Amsterdam, Amsterdam, The Netherlands
Correspondence: Dr Johannes J. van Lieshout (email j.j.vanlieshout@amc.uva.nl).
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Publisher: Portland Press Ltd
Received:
December 20 2007
Revision Received:
February 25 2008
Accepted:
March 18 2008
Accepted Manuscript online:
March 18 2008
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2008 Biochemical Society
2008
Clin Sci (Lond) (2008) 115 (8): 255–262.
Article history
Received:
December 20 2007
Revision Received:
February 25 2008
Accepted:
March 18 2008
Accepted Manuscript online:
March 18 2008
Citation
Yu-Sok Kim, Rogier V. Immink, Wim J. Stok, John M. Karemaker, Niels H. Secher, Johannes J. van Lieshout; Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes. Clin Sci (Lond) 1 October 2008; 115 (8): 255–262. doi: https://doi.org/10.1042/CS20070458
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