Changes Of Pulse Wave Velocity And Its Influential Factors In Patients With Type 2 Diabetes

Reproducibility of pulse wave velocity measurementObjective To evaluate the reproducibility and validity of central and peripheral wave velocity measurement.Methods Carotid-femoral(CF),Carotid-radial(CR) and Carotid- dorsum of foot(CD) pulse wave velocity(PWV) measurements were performed by two observers in 30 subjects including 20 healthy volunteers and 10 patients with major risk factors of cardiovascular diseases in the elderly in two separate days with 3 exams each day respectively.Results The variation coefficients of the three artery PWVs between observers were 4%,4%,5% respectively. There was no statistical difference of the inter-observer in the three artery PWVs (P>0.05) .The interclass correlation coefficient efficients were 0.75,0.93,0.49 respectively. The reproducibility was also very good as shown by Bland-Altman plot, most of the values lying within 2SD. The variation coefficients of the intra-observer for the three arteries were 7%,4%,6% respectively. There was no statistical difference of the three artery PWVs within observers (P>0.05) .The interclass correlation coefficients were 0.57,0.94,0.40 respectively. There was a strong, significant linear correlation between CF-PWV and CR-PWV,between CF-PWV and CD-PWV.The Pearson's correlation coefficient were 0.448,0.611 (P=0.013,P=0.000) respectively. But there was no linear correlation between CR-PWV and CD-PWV (P>0.05) .Conclusion Pulse wave velocity measurement showed good reproducibility by automatic PWV measuring system (Complior SP , France) . Changes of Pulse Wave Velocity and its and Influential Factors in Patients with Type 2 DiabetesObjective To study the changes of pulse wave velocity (PWV) and its influential factors in the patients with Type 2 Diabetes. To observe the changes of PWV of diabetic patients treated by insulin pump.Methods Between September 2008 and January 2009,48 patients were consecutively enrolled in this study. Ages ranged from 42 to 87 years(mean,64.5±13 years),with 30 male and 18 female patients. According to the different complications, diabetic patients were divided into six groups: group 1 without any complications(n=20), group 2 with hypertension and or coronary heart disease(n=28),group 3 with urinary albumin excretion rate(UAER)<20ug/min(n=28), group 4 with UAER≥20ug/min(n=20), group 5 without diabetic retinopathy (n=26),and group 6 with retinopathy (n=22).Meanwhile,22 healthy people were recruited as control group. Ages ranged from 40 to 84 years(mean,59±12.4 years),with 12 male and 10 female. Automatic PWV measuring system was applied to examine carotid-femoral PWV (CF-PWV),carotid-radial PWV (CR-PWV) and carotid-dorsum of foot PWV (CD-PWV),which reflect central elastic large arterial and peripheral muscular medium sized arterial elasticity. Group 5 was treated by insulin pump until fasting blood glucose lowering to 5～7mmol/L, postprandial blood glucose dropping to 7～10mmol/L and maintaining the level for one week. PWV was examined once before and after the treatment.Results Compared with the control group, CF-PWV of all the diabetic patients with or without complications significantly increased(P<0.05) ,CD-PWV of the patients with complications showed statistical significance(P<0.05).The four factors hypertension,coronary heart disease, urinary albumin excretion rate(UAER) and diabetic retinopathy could significantly influence the CF-PWV of the patients with Type 2 Diabetes(P<0.05).The CD-PWV of patients with diabetic retinopathy was higher than that of patients without retinopathy. Our study didn't demonstrate any statistical significance of CR-PWV among the groups .CF-PWV significantly correlated with age, systolic blood pressure,pulse pressure ,duration of diabete,UAER and diabetic retinopathy(r=0.57,0.38,0.51,0.44,0.449,0.319; P<0.05 respectively). Multiple regression analysis demonstrated an independent association between PWV and age (P<0.05), UAER (P<0.05).There gression equation was: CF-PWV=4.868+ 0.116Age+0.0059UAER.The treatment of insulin pump didn't produce significant influence to PWV of group 5.Conclusion Central elastic large arterial elasticity increases more significantly and earlier than peripheral muscular medium sized arterial in type 2 diabetes patients, especially in patients accompanied by hypertension, coronary heart disease ,urinary protein or diabetic retinopathy. Age,systolic blood pressure,pulse pressure,duration of diabetes,UAER and diabetic retinopathy were closely related to the aortic stiffness and compliance's-PWV seems to be a sensitive index for early vascular function alteration. Short-term treatment of insulin pump can not definitely improve the aortic stiffness and compliance.