70 JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA • APRIL 2014 • VOL.

62
1
Prof. and H.O.U.,
2
Assoc. Prof.,
3
P.G. Resident,
4
Prof. and H.O.D.,
Dept. of Medicine, Dr. D.Y. Patil
Medical College and Hospital,
Pimpri , Pune
Received: 24.12.2012;
Revised: 05.03.2013;
Accepted; 06.03.2013
Sir,
T
his is with reference to the original
article published as “Endothelium-
dependant brachial artery flow-mediated
vasodilatation in patient with diabetes
mellitus with and without coronary
artery disease” by K Bhargava et al,
1
an
important information on the subject
of endothelial dysfunction in the north
Indian population. May I add some
additional details in it. We conducted
a study on endothel i al dysfuncti on
in diabetes mellitus on a group of 50
consecutive patients of diabetes mellitus
and cor related them with the severity,
duration and HbA1C levels.
We found a significant inverse relation
bet ween durat i on and endot hel i al
dysfunction in diabetes mellitus which
was al so observed by Johnstone et
al.
2
We also found that there was an
inverse relation between HbA1C and
endothel i al dysfuncti on whi ch was
also observed by Furomoto et al.
3
In
our st udy, 5 pat i ent s had di abet i c
retinopathy, 7 had non-proliferative
diabetic retinopathy and 38 had normal
fundoscopic picture. FMD values were
less in patients with diabetic retinopathy
(91.8 ± 15.01) compared to those in whom
there was non proliferative diabetic
retinopathy (94.71 ± 10.56) which was
also less than in patients with normal
fundoscopic picture (106.54 ± 13.80).
The probability value was less than 0.05
which shows that there was statistical
significance. Sogawa et al
4
in their study
of 74 patients proved that there was a
significant inverse relationship between
diabetic retinopathy and flow mediated
dilatation.
I n our st udy, 18 pat i ent s had
albuminuria and 32 patients had no
Study of Endothelial Dysfunction in Diabetes
Mellitus by Doppler Flow Mediated Dilatation of
Brachial Artery
Prasanna Kumar Satpathy
1
, Pradnya Mukund Diggikar
2
, Preeti Birasaheb Rupnar
3
,
Arjun Lal Kakrani
4
, Harmandeep Chahal
3
al bumi nuri a. There was a marked
decrease in flow mediated dilatation
in patients in whom albuminuria was
present (95 ± 14. 2) than i n those i n
whom it was absent (108.1 ± 12.4). The
probability value was less than 0.003
which was highly significant. Steuhover
et al
5
in their HOORN study showed that
there was an inverse relationship between
microalbuminuria and flow mediated
dilatation which was significant. Also,
i t was found that FMD val ues were
less in diabetic patients (93.23 ± 6.68),
compared to patients with impaired
glucose values (108.64 ± 5.30) which was
less as compared to patients with normal
gl ucose val ues ( 124. 09 ± 8. 95) . The
probability value was < 0.0001 which is
highly significant. Kawano et al
6
in their
study showed that there was a significant
correl ati on between pl asma gl ucose
levels and flow mediated dilatation.
Ravikumar et al
7
have compared the
FMD and Augmentation Index (AI) in
diabetic and non-diabetic subjects and
correlated these measurements with
the carotid IMT in the CUPS-9 study.
2

FMD values were significantly lower
among diabetic subjects compared with
non-diabetic subjects (2.1 ± 2.95% vs
6.64 ± 4.38%, p < 0.0001). At any given
age, di abet i c subj ect s i n t he st udy
had significantly higher AI and lower
FMD values compared to non-diabetic
subj ects. Chugh et al
8
evaluated the
effect of glycaemia on FMD endothelial
function in type 2 diabetic patients have
reported significant improvements in
endothelial function after 12 weeks of
treatment during which there was a
concomitant significant improvement in
glycaemic control in them. Regardless
of whether these patients started with
a low or very low FMD in those with
364  © JAPI • APRIL 2014 • VOL. 62
JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA • APRIL 2014 • VOL. 62 71
fair or poor glycaemic control, the FMD values
reached close to those observed in the control group
once excellent glycaemic control was achieved in
them. These results point to a significant reversible
component of endot hel i al dysf unct i on t hat i s
amenable to good glycaemic control at least in those
diabetic subjects who did not already have evidence
of clinical vascular disease such as hypertension,
or other macroangiopathy. Earlier studies have not
reported effects of glycaemic control in improving
endothelial function in diabetes and if confirmed
in a larger subset of diabetic patients the results of
the present study would provide all physicians yet
another reason to strive for achieving strict glycaemic
control in diabetic patients.
To concl ude, f l ow medi at ed di l at at i on was
inversely related to diabetic neuropathy, diabetic
retinopathy,diabetic nephropathy and blood sugar
values, HbA1C and duration of diabetes mellitus.
However,the sample size should be sufficiently large
and should include multicentric studies to arrive at a
definite conclusion.
References
1. Bhargava K, Hansa G, Bansal M, Tandon S, Kasliwal RR. endothelium-
dependant brachial artery fow-mediated vasodilatation in patient
with diabetes mellitus with and without coronary artery disease.
Journal of the Association of Physicians of India 2003;51:355-8.
2. Johnstone MT, Creager SJ, Scales KM, Cusko JA, Lee BK, Creager MA.
Impaired endothelium-dependent vasodilation in patients with
insulin-dependent diabetes mellitus. Circulation 1993;88:2510-2516.
3. Tomoo Furumoto, Satoshi Fujii, Naotaka Saito,Taisei Mikami, and
Akira Kitabatake. Relationships between Brachial Artery Flow
Mediated Dilation and Carotid Artery Intima-Media Thickness in
Patients with Suspected Coronary Artery Disease. Japanese Heart
Journal 2002;43:117-125.
4. Sogawa K, Nagaoka T, Tanano I, Tani T, Omae T, Nakabayashi S,
Ishibazawa A, Takahashi A, Yoshida A. Association between diabetic
retinopathy and fow-mediated vasodilation in type 2 DM. Current
Eye Research 2012;37:446-51.
5. Stehouwer CD, Henry RM, Dekker JM, Nijpels G, Heine RJ, Bouter
LM. Microalbuminuria is associated with impaired brachial artery,
fow-mediated vasodilation in elderly individuals without and with
diabetes: further evidence for a link between microalbuminuria
and endothelial dysfunction--the Hoorn Study. Kidney Int Suppl.
2004;11:S42-44.
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Hirai, Yuji Miyao, Tomohiro Sakamoto, Kiyotaka Kugiyama, Hisao
Ogawa, Hirofumi Yasue. Hyperglycemia rapidly suppresses fow
mediated endothelium- dependent vasodilation of brachial artery.
Journal of the American College of Cardiology 1999;34:46-154.
7. Ravikumar R, Deepar R, Shanthirani S, Mohan V. Comparison of
carotid intima-media thickness, arterial shifness and brachial artery
fow-mediated dilatation in diabetic and nondiabetic subjects. (The
Chennai Urban Population Study (CUPS-9). Am J Cardiol 2002;90:702-
7.
8. S.N.Chugh, Surekha Dabla, Vinish Jain, Kiran Chugh, Jyotsna
Sen. Evaluation of Endothelial Function and Effect of glycemic
Control(Excellent Vs Poor/Fair Control)on endothelial Function in
Uncontolled Type 2 Diabetes Mellitus. Journal of the Association of
Physicians of India 2010;58:478-480.
© JAPI • APRIL 2014 • VOL. 62  365

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