The relationship between nephropathy, retinopathy, obesity and arterial stiffness in type 2 diabetes mellitus

Öz

Objectives: In this trial, we aimed to define arterial stiffness (AS) parameters in patients with type 2 diabetes mellitus (DM) without any known coronary heart disease and compare our results with the incidence of complications of type 2 DM like abdominal obesity, nephropathy and retinopathy in our study population.

Patients and methods: We included 110 type 2 DM patients between the ages of 30-80, without any coronary heart disease with estimated glomerular filtration rate (eGFR) value of above 30 m/min/1.73 m2 to our study. We recorded patients’, body weight, body mass indexes (BMI), conicity indexes (CI), waist circumferences, onset of diabetes, smoking habits, fundus evaluation, hypertension and hyperlipidemia background. Moderately increased albuminuria was used as a marker to identify the diabetic nephropathy. We measured the pulse wave velocity (PWV), augmentation index (AIx), arterial blood pressure of patients by using Mobil-O-Graph® ARC solver algorithm” device.

Results: PWV values were positively associated with CI, onset of type 2 DM, and systolic blood pressure. PWV values were negatively associated with eGFR. AIx values were positively associated with BMI, systolic blood pressure and heart rate. AIx values were negatively associated with hemoglobin level. Hypertension was positively associated with PWV. Smoking habits was negatively associated with AIx. There were no statistically association among complications of diabetes such as nephropathy, retinopathy and PWV, AIx values.

Conclusion: There were associations between AS and CI, eGFR, hemoglobin level, onset of diabetes, arterial blood pressure values of type 2 DM patients. There were no association between AS and nephropathy, retinopathy rates of type 2 DM patients. We assume that AS is an independent novel cardiovascular risk factor for patients diagnosed with obesity, anemia, hypertension and type 2 DM.

Keywords: Arterial stiffness; diabetes mellitus; nephropathy; obesity; retinopathy.

Anahtar Kelimeler

• Arterial stiffness
• diabetes mellitus
• nephropathy
• obesity
• retinopathy

Tip 2 diabetes mellitus tanılı hastalarda nefropati, retinopati, obezite ve arteriyel sertlik arasındaki ilişki

Öz

Amaç: Bu çalışmada, bilinen koroner arter hastalık öyküsü olmayan tip 2 diyabetes mellitus (DM) tanılı hastalarda arteriyel sertlik parametrelerinin belirlenmesi ve arteriyel sertliğin abdominal obezite, nöropati, nefropati gibi diyabetes mellitus komplikasyonları ile karşılaştırılmasını amaçladık.Hastalar ve yöntemler: Çalışmamıza; tip 2 DM tanılı, koroner arter hastalık öyküsü olmayan, tahmini glomerüler filtrasyon hızı (eGFR): 30 mL/min/1.73 m2’nin üzerinde olan, 30-80 yaş arasında bulunan 110 hasta dahil edildi. Hastaların vücut ağırlığı, vücut kütle indeksi (VKİ), konisite indeksi (Kİ), bel çevresi, laboratuvar tetkikleri, diyabet süresi, sigara kullanımı, göz dibi bakısı, hipertansiyon ve hiperlipidemi öyküsü kaydedildi. Diyabetik nefropatiyi tanımlamak için belirteç olarak orta derecede artmış albuminüri kullanıldı. Hastaların nabız dalga hızı (NDH), augmentasyon indeksi (AIx) ve arteriyel kan basıncı, ”Mobil-O-Graph® ARC solver algorithm” cihazı ile tek koldan ölçüldü.Bulgular: NDH değerleri ile CI, tip 2 DM süresi ve arteriyel kan basıncı arasında pozitif yönlü ilişki saptandı. NDH ve eGFR değeri arasında ise negatif yönlü bir ilişki vardı. Alx değerleri ile VKİ , sistolik kan basıncı ve kalp hızı arasında pozitif yönlü Ilişki vardı. AIx değerleri ile hemoglobin düzeyi arasında ise negatif yönlü bir ilişki vardı. Hipertansiyon ile NDH pozitif ilişkili idi. Sigara içimi ile AIx negatif yönlü ilişkili idi. Hastaların diyabet komplikasyonları (nefropati ve retinopati) ile NDH ve Alx arasında istatistiksel olarak anlamlı bir fark saptanmadı.Sonuç: Tip 2 DM'li hastaların Kİ, eGFR, hemoglobin düzeyleri , tip 2 DM süresi ve arteriyel kan basıncı; arteriyel sertlik ile ilişkili idi. Nefropati ve retinopati ile arteriyel sertlik arasında ilişki saptanmadı. Arteriyel sertliğin obezite, anemi, esansiyel hipertansiyon ve tip 2 DM tanılı hastalarda kardiyovasküler olaylar için bağımsız bir risk faktörü olduğunu düşünüyoruz

Anahtar Kelimeler

• Arteriyel sertlik
• diyabetes mellitus
• nefropati
• obezite
• retinopati

Kaynakça

1. 1. King H, Rewers M. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group. Diabetes Care 1993;16:157-77.
2. 2. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414-31.
3. 3. Satman ‹, Yılmaz T. Dünyada ve Türkiye’de obezite epidemiyolojisi. Aktüel Tıp Dergisi 2001;6:9-12.
4. 4. Satman ‹ ve TURDEP-II Çalıma Grubu. 32. TEMH Kongresi 13-17 Ekim 2010, Antalya.
5. 5. Laakso M. Tip 2 diyabetin epidemiyolojisi ve tanısı. In: Goldstein BJ, Müler-Wieland D, editors. Textbook of Type 2 Diabetes. New York: Martin Dunitz Group 2003. Çeviri Ed: Akman AC. 1. Baskı. ‹stanbul: AND Yayıncılık; 2004. s. 1-12.
6. 6. Yenigün M. Her yönüyle diabetes mellitus. 2. Baskı. ‹stanbul: Nobel Tıp Kitabevi; 2001.
7. 7. Kolo¤lu S. Diyabetes mellitus. In: Kolo¤lu S, editör. Endokrinoloji Temel ve Klinik. 1. Baskı. Ankara: Medical Network & Nobel; 1996. s. 368-85.
8. 8. ‹liçin G, Bibero¤lu K, Süleymanlar G, Ünal S. ‹ç hastalıkları. Ankara: Güne Kitabevi; 2003. s. 51.

9. 9. Mogensen CE. Microalbuminuria, blood pressure and development on ideas. Diabetologica 1999;41:736-41.
10. 10. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588-605.
11. 11. Laurent S, Boutouyrie P. Recent advances in arterial stiffness and wave reflection in human hypertension. Hypertension 2007;49:1202-6.
12. 12. Akdam H, Ö¤ünç H, Alp A, Özbek Ö, Ömürlü ‹K, Yeniçerio¤lu Y, et al. Assessment of volume status and arterial stiffness in chronic kidney disease. Ren Fail 2014;36:28-34.
13. 13. Jatoi NA, Mahmud A, Bennett K, Feely J. Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniques. J Hypertens 2009;27:2186-91.
14. 14. Horváth IG, Németh A, Lenkey Z, Alessandri N, Tufano F, Kis P, et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J Hypertens 2010;28:2068-75.
15. 15. Baulmann J, Schillings U, Rickert S, Uen S, Düsing R, Illyes M, et al. A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods. J Hypertens 2008;26:523-8.
16. 16. McEniery CM, Yasmin, McDonnell B, Munnery M, Wallace SM, Rowe CV, et al. Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II. Hypertension 2008;51:1476-82.
17. 17. Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006;113:664-70.
18. 18. Theilade S, Lajer M, Persson F, Joergensen C, Rossing P. Arterial stiffness is associated with cardiovascular, renal, retinal, and autonomic disease in type 1 diabetes. Diabetes Care 2013;36:715-21.
19. 19. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002;106:2085-90..
20. 20. Evans PD, McIntyre NJ, Fluck RJ, McIntyre CW, Taal MW. Anthropomorphic measurements that include central fat distribution are more closely related with key risk factors than BMI in CKD stage 3. PLoS One 2012;7:34699.
21. 21. Smith A, Karalliedde J, De Angelis L, Goldsmith D, Viberti G. Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes. J Am Soc Nephrol 2005;16:1069-75.
22. 22. Mourad JJ, Pannier B, Blacher J, Rudnichi A, Benetos A, London GM, et al. Creatinine clearance, pulse wave velocity, carotid compliance and essential hypertension. Kidney Int 2001;59:1834-41.
23. 23. Aoun S, Blacher J, Safar ME, Mourad JJ. Diabetes mellitus and renal failure: effects on large artery stiffness. J Hum Hypertens 2001;15:693-700.
24. 24. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006;113:1213-25.
25. 25. Kim SG, Ryu OH, Kim HY, Lee KW, Seo JA, Kim NH, et al. Effect of rosiglitazone on plasma adiponectin levels and arterial stiffness in subjects with prediabetes or non-diabetic metabolic syndrome. Eur J Endocrinol 2006;154:433-40.
26. 26. Smith A, Karalliedde J, De Angelis L, Goldsmith D, Viberti G. Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes. J Am Soc Nephrol 2005;16:1069-75.
27. 27. Yun YW, Shin MH, Lee YH, Rhee JA, Choi JS. Arterial stiffness is associated with diabetic retinopathy in Korean type 2 diabetic patients. J Prev Med Public Health 2011;44:260-6.
28. 28. Dahlén EM, Tengblad A, Länne T, Clinchy B, Ernerudh J, Nystrom FH, et al. Abdominal obesity and low-grade systemic inflammation as markers of subclinical organ damage in type 2 diabetes. Diabetes Metab 2014;40:76-81
29. 29. Teoh W, Price JF, Williamson RM, Payne RA, Van Look LA, Reynolds RM, et al. Metabolic parameters associated with arterial stiffness in older adults with Type 2 diabetes: the Edinburgh Type 2 diabetes study. J Hypertens 2013;31:1010-7.
30. 30. Nagano M, Nakamura M, Sato K, Tanaka F, Segawa T, Hiramori K. Association between serum C-reactive protein levels and pulse wave velocity: a populationbased cross-sectional study in a general population. Atherosclerosis 2005;180:189-95.
31. 31. Mattace-Raso FU, van der Cammen TJ, van der Meer IM, Schalekamp MA, Asmar R, Hofman A, et al. C-reactive protein and arterial stiffness in older adults: the Rotterdam Study. Atherosclerosis 2004;176:111-6.