This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bagg, W. Articles by Braatvedt, G. D. Search for Related Content PubMed PubMed Citation Articles by Bagg, W. Articles by Braatvedt, G. D.

The Influences of Obesity and Glycemic Control on Endothelial Activation in Patients with Type 2 Diabetes

Department of Medicine (W.B., G.G., P.O., G.D.B.), University of Auckland, 1000 Auckland, New Zealand; and Department of Internal Medicine and Public Health, University of L’Aquila (C.F., G.D.), 67100 L’Aquila, Italy

Address all correspondence and requests for reprints to: Dr. W. Bagg, Department of Medicine, 4th Floor, Auckland Hospital, Park Road, Grafton, 1000 Auckland, New Zealand. E-mail: w.bagg{at}auckland.ac.nz

Abstract

The aims of this study were to elucidate the factors that contribute to endothelial activation and fibrinolytic abnormalities in patients with poorly controlled type 2 diabetes and to determine whether improved glycemic control reduces endothelial activation. Adhesion molecules [E-selectin, intracellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1], von Willebrand factor, total nitric oxide (NO), endothelin-1, tissue plasminogen activator, and plasminogen activator inhibitor-1 were measured in 43 type 2 diabetic subjects with hemoglobin A_1c of 9.0% or more at baseline (compared with 21 healthy controls) who after 20 wk had been randomized to either improved (IC) or usual (UC) glycemic control. At baseline, type 2 diabetic patients had significant endothelial activation and abnormal fibrinolysis compared with control subjects. Body mass index in the diabetic patients was the only independent predictor of E-selectin (P = 0.007), ICAM-1 (P = 0.01), and NO (P = 0.008) concentrations, but not vascular cell adhesion molecule-1, plasminogen activator inhibitor-1, or tissue plasminogen activator (all P > 0.05). Type 2 diabetic patients with a body mass index of 28 kg/m² or less had concentrations of E-selectin, ICAM-1, endothelin-1, and NO similar to those in healthy controls. After 20 wk, hemoglobin A_1c was significantly lower in IC vs. UC (IC, 8.02 ± 0.25%; UC, 10.23 ± 0.23%; P < 0.0001), but there were no significant changes in markers of endothelial activation or indexes of fibrinolysis.

Obesity appears to be the most important predictor of endothelial activation in patients with type 2 diabetes. Short-term improvement in glycemic control does not appear to reduce endothelial activation.

This article has been cited by other articles:

				M. V. Jimenez, R. M. Estepa, R. M. Camacho, R. C. Estrada, F. G. Luna, and F. B. Guitarte Endothelial dysfunction is related to insulin resistance and inflammatory biomarker levels in obese prepubertal children Eur. J. Endocrinol., April 1, 2007; 156(4): 497 - 502. [Abstract] [Full Text] [PDF]

				S. McQuaid, D. J. O'Gorman, O. Yousif, T. P. Yeow, Y. Rahman, D. Gasparro, G. Pacini, and J. J Nolan Early-Onset Insulin-Resistant Diabetes in Obese Caucasians Has Features of Typical Type 2 Diabetes, but 3 Decades Earlier Diabetes Care, May 1, 2005; 28(5): 1216 - 1218. [Full Text] [PDF]

				L. A. Vazquez, F. Pazos, J. R. Berrazueta, C. Fernandez-Escalante, M. T. Garcia-Unzueta, J. Freijanes, and J. A. Amado Effects of Changes in Body Weight and Insulin Resistance on Inflammation and Endothelial Function in Morbid Obesity after Bariatric Surgery J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 316 - 322. [Abstract] [Full Text] [PDF]

				K. J. Mather, A. Lteif, H. O. Steinberg, and A. D. Baron Interactions Between Endothelin and Nitric Oxide in the Regulation of Vascular Tone in Obesity and Diabetes Diabetes, August 1, 2004; 53(8): 2060 - 2066. [Abstract] [Full Text] [PDF]

				L. Li, T. Sawamura, and G. Renier Glucose Enhances Endothelial LOX-1 Expression: Role for LOX-1 in Glucose-Induced Human Monocyte Adhesion to Endothelium Diabetes, July 1, 2003; 52(7): 1843 - 1850. [Abstract] [Full Text] [PDF]

				S. T. Knudsen, C. H. Foss, P. L. Poulsen, T. Bek, T. Ledet, C. E. Mogensen, and L. M. Rasmussen E-selectin-inducing activity in plasma from type 2 diabetic patients with maculopathy Am J Physiol Endocrinol Metab, January 1, 2003; 284(1): E1 - E6. [Abstract] [Full Text] [PDF]

				M. Laakso and J. Kuusisto Diabetology for cardiologists Eur. Heart J. Suppl., January 1, 2003; 5(suppl_B): B5 - B13. [Abstract] [PDF]

				K. Esposito, A. Pontillo, M. Ciotola, C. Di Palo, E. Grella, G. Nicoletti, and D. Giugliano Weight Loss Reduces Interleukin-18 Levels in Obese Women J. Clin. Endocrinol. Metab., August 1, 2002; 87(8): 3864 - 3866. [Abstract] [Full Text] [PDF]