Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes

Yu-Sok Kim; Rogier V. Immink; Wim J. Stok; John M. Karemaker; Niels H. Secher; Johannes J. van Lieshout

doi:https://doi.org/10.1042/CS20070458

Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes

Yu-Sok Kim, Rogier V. Immink, Wim J. Stok, John M. Karemaker, Niels H. Secher, Johannes J. van Lieshout

Research output: Contribution to journal › Article › Academic › peer-review

77 Citations (Scopus)

Abstract

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 V(mean) (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 V(mean) transfer function was 52+/-10 degrees in CTRL subjects, reduced in subjects with DM- (40+/-6 degrees ; P <0.01 compared with CTRL subjects) and impaired in subjects with DM+ (30+/-5 degrees ; 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 V(mean) 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+). HbA(1c) (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

Original language	English
Pages (from-to)	255-262
Number of pages	8
Journal	Clinical science (London, England
Volume	115
Issue number	7-8
DOIs	https://doi.org/10.1042/CS20070458
Publication status	Published - Oct 2008

Keywords

Adult
Blood Pressure
Carbon Dioxide/blood
Cerebrovascular Circulation
Diabetes Mellitus, Type 2/diagnostic imaging
Diabetic Angiopathies/diagnostic imaging
Female
Homeostasis
Humans
Male
Middle Aged
Middle Cerebral Artery/diagnostic imaging
Partial Pressure
Posture
Time Factors
Ultrasonography, Doppler, Transcranial

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https://doi.org/10.1042/CS20070458

Cite this

@article{0cd42c773c5a45d5b38ded66287aa84d,

title = "Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes",

abstract = "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 V(mean) (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 V(mean) transfer function was 52+/-10 degrees in CTRL subjects, reduced in subjects with DM- (40+/-6 degrees ; P <0.01 compared with CTRL subjects) and impaired in subjects with DM+ (30+/-5 degrees ; 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 V(mean) 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+). HbA(1c) (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",

keywords = "Adult, Blood Pressure, Carbon Dioxide/blood, Cerebrovascular Circulation, Diabetes Mellitus, Type 2/diagnostic imaging, Diabetic Angiopathies/diagnostic imaging, Female, Homeostasis, Humans, Male, Middle Aged, Middle Cerebral Artery/diagnostic imaging, Partial Pressure, Posture, Time Factors, Ultrasonography, Doppler, Transcranial",

author = "Yu-Sok Kim and Immink, {Rogier V.} and Stok, {Wim J.} and Karemaker, {John M.} and Secher, {Niels H.} and {van Lieshout}, {Johannes J.}",

year = "2008",

month = oct,

doi = "https://doi.org/10.1042/CS20070458",

language = "English",

volume = "115",

pages = "255--262",

journal = "Clinical science (London, England",

issn = "0143-5221",

publisher = "Portland Press Ltd.",

number = "7-8",

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TY - JOUR

T1 - Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes

AU - Kim, Yu-Sok

AU - Immink, Rogier V.

AU - Stok, Wim J.

AU - Karemaker, John M.

AU - Secher, Niels H.

AU - van Lieshout, Johannes J.

PY - 2008/10

Y1 - 2008/10

N2 - 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 V(mean) (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 V(mean) transfer function was 52+/-10 degrees in CTRL subjects, reduced in subjects with DM- (40+/-6 degrees ; P <0.01 compared with CTRL subjects) and impaired in subjects with DM+ (30+/-5 degrees ; 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 V(mean) 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+). HbA(1c) (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

AB - 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 V(mean) (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 V(mean) transfer function was 52+/-10 degrees in CTRL subjects, reduced in subjects with DM- (40+/-6 degrees ; P <0.01 compared with CTRL subjects) and impaired in subjects with DM+ (30+/-5 degrees ; 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 V(mean) 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+). HbA(1c) (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

KW - Adult

KW - Blood Pressure

KW - Carbon Dioxide/blood

KW - Cerebrovascular Circulation

KW - Diabetes Mellitus, Type 2/diagnostic imaging

KW - Diabetic Angiopathies/diagnostic imaging

KW - Female

KW - Homeostasis

KW - Humans

KW - Male

KW - Middle Aged

KW - Middle Cerebral Artery/diagnostic imaging

KW - Partial Pressure

KW - Posture

KW - Time Factors

KW - Ultrasonography, Doppler, Transcranial

U2 - https://doi.org/10.1042/CS20070458

DO - https://doi.org/10.1042/CS20070458

M3 - Article

C2 - 18348713

SN - 0143-5221

VL - 115

SP - 255

EP - 262

JO - Clinical science (London, England

JF - Clinical science (London, England

IS - 7-8

ER -