Different Measures of Hyperglycemia Are Negatively Associated With Skin Microvascular Flowmotion: The Maastricht Study

IF 1.9 4区医学 Q3 HEMATOLOGY Microcirculation Pub Date : 2024-08-22 DOI:10.1111/micc.12882

X. Zhao, C. Schalkwijk, A. Kroon, M. T. Schram, C. Stehouwer, A. Houben

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Abstract

Objective

Diabetes can lead to microvascular complications such as diabetic neuropathy, nephropathy, and retinopathy. Hyperglycemia may initiate microvascular function impairment early in the course of diabetes, even prior to its clinical establishment during the pre-diabetes stage. Microvascular vasomotion, that is, the rhythmic arteriolar constriction and dilation, is an important function that regulates oxygen and nutrient delivery within the tissue and regulates peripheral resistance. Using laser Doppler flowmetry (LDF), vasomotion in skin microcirculation can be measured as flowmotion. Changes in flowmotion have been shown in individuals with obesity, and type 1 or type 2 diabetes mellitus. However, no data are available on associations between hyperglycemia and flowmotion in the general population. Our aim was to study whether measures of hyperglycemia were associated with different components of skin microvascular flowmotion (SMF) in a population-based cohort (The Maastricht Study).

Methods

Data from 7293 participants of The Maastricht Study were used. SMF was measured using LDF. Endothelial, neurogenic and myogenic component SMF power were used as dependent variables. We investigated the associations of glucose metabolism status (normal glucose metabolism, prediabetes, and type 2 diabetes mellitus), measures of hyperglycemia (fasting plasma glucose [FPG], 2-h post-load glucose [2 h-PG], HbA1c, advanced glycation end-products [AGEs] assessed as skin autofluorescence [SAF]), and indices of glucose variability (incremental glucose peak [IGP] and continuous glucose monitoring [CGM] -assessed as standard deviation [SD]) with each component of SMF power. We used linear regression analyses with adjustments for confounders, and trend analyses.

Results

We observed consistent negative associations between HbA1c levels and all three (endothelial, neurogenic, and myogenic) skin microvascular flowmotion (SMF) powers in the additionally adjusted model. Similarly, in the conservative model, we found that multiple hyperglycemia metrics such as GMS trend, PreD, T2DM, FPG, 2 h-PG, and HbA1c were consistently negatively associated with all three SMF powers.

Conclusions

We showed that skin microvascular flowmotion is reduced in individuals with (pre)diabetes. In addition, different measures of hyperglycemia are negatively associated with skin microvascular flowmotion.

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不同的高血糖测量值与皮肤微血管流动呈负相关：马斯特里赫特研究

目的：糖尿病可导致微血管并发症，如糖尿病神经病变、肾病和视网膜病变。高血糖可能在糖尿病病程的早期，甚至在糖尿病前期临床症状出现之前，就已经开始损害微血管功能。微血管运动，即有节奏的动脉收缩和扩张，是调节组织内氧气和营养输送以及调节外周阻力的重要功能。利用激光多普勒血流测量仪（LDF），可将皮肤微循环中的血管运动测量为血流运动。肥胖症患者、1 型或 2 型糖尿病患者的血流运动都会发生变化。然而，目前还没有关于普通人群中高血糖与血流运动之间关系的数据。我们的目的是研究在一个基于人群的队列（马斯特里赫特研究）中，高血糖的测量值是否与皮肤微血管流动（SMF）的不同组成部分有关：方法：采用马斯特里赫特研究 7293 名参与者的数据。采用 LDF 测量 SMF。内皮、神经源和肌源性成分 SMF 功率被用作因变量。我们研究了葡萄糖代谢状态（正常葡萄糖代谢、糖尿病前期和 2 型糖尿病）、高血糖测量值（空腹血浆葡萄糖[FPG]、负荷后 2 小时血糖[2 h-PG]、HbA1c、高级糖化终产物[高级糖化终产物]）与 SMF 的相关性、高级糖化终产物[AGEs]，以皮肤自发荧光[SAF]评估），以及葡萄糖变异性指数（增量葡萄糖峰值[IGP]和连续葡萄糖监测[CGM]，以标准差[SD]评估）与 SMF 功率的每个组成部分。我们采用了线性回归分析，并对混杂因素进行了调整，还进行了趋势分析：结果：在附加调整模型中，我们观察到 HbA1c 水平与所有三种（内皮、神经源和肌源性）皮肤微血管血流运动（SMF）功率之间存在一致的负相关。同样，在保守模型中，我们发现 GMS 趋势、PreD、T2DM、FPG、2 h-PG 和 HbA1c 等多个高血糖指标与所有三种 SMF 功率均呈负相关：我们的研究表明，糖尿病（前期）患者的皮肤微血管流动性降低。结论：我们的研究表明，糖尿病（前期）患者的皮肤微血管流动性降低，此外，不同的高血糖测量指标与皮肤微血管流动性呈负相关。

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来源期刊

Microcirculation 医学-外周血管病

CiteScore

5.00

自引率

4.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal features original contributions that are the result of investigations contributing significant new information relating to the vascular and lymphatic microcirculation addressed at the intact animal, organ, cellular, or molecular level. Papers describe applications of the methods of physiology, biophysics, bioengineering, genetics, cell biology, biochemistry, and molecular biology to problems in microcirculation. Microcirculation also publishes state-of-the-art reviews that address frontier areas or new advances in technology in the fields of microcirculatory disease and function. Specific areas of interest include: Angiogenesis, growth and remodeling; Transport and exchange of gasses and solutes; Rheology and biorheology; Endothelial cell biology and metabolism; Interactions between endothelium, smooth muscle, parenchymal cells, leukocytes and platelets; Regulation of vasomotor tone; and Microvascular structures, imaging and morphometry. Papers also describe innovations in experimental techniques and instrumentation for studying all aspects of microcirculatory structure and function.

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