Hypoglycemia does not affect the progression of preclinical atherosclerosis in subjects with type 2 diabetes

• Published in: PloS one Vol. 14; no. 3; p. e0212871
• Main Authors: Irace, Concetta, Cutruzzolà, Antonio, Carbotti, Delia Francesca, Mastroianni, Simona, Cavallo, Michela, Gnasso, Agostino
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.03.2019; Public Library of Science (PLoS)
• Subjects: Aged; Arteries; Arteriosclerosis; Atherosclerosis; Atherosclerosis - blood; Atherosclerosis - diagnostic imaging; Atherosclerosis - etiology; Biology and Life Sciences; Blood Glucose - drug effects; Blood Glucose - physiology; Blood pressure; Brachial Artery - diagnostic imaging; Brachial Artery - pathology; Carotid arteries; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Carotid Intima-Media Thickness; Clinical trials; Complications; Development and progression; Diabetes; Diabetes Complications - etiology; Diabetes Complications - prevention & control; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Disease Progression; Endothelium; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - pathology; Family medical history; Fasting; Female; Glucose; Glycated Hemoglobin A - analysis; Glycosylated hemoglobin; Hemoglobin; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemia - blood; Hypoglycemia - chemically induced; Hypoglycemia - complications; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Inflammation; Insulin; Lipids - blood; Male; Medicine; Medicine and Health Sciences; Middle Aged; Morphology; Mortality; Noninvasive evaluation; Outpatient care facilities; Prospective Studies; Reduction; Risk Factors; Systematic review; Type 2 diabetes; Ultrasonography; Wall thickness; Italy; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0212871

Intensive treatment aimed at achieving optimal metabolic control to prevent the development of chronic diabetic complications is often associated with an increased rate of hypoglycemic events. Hypoglycemia is believed to be responsible for acute fatal and nonfatal cardiovascular events likely as a consequence of the activation of pro-inflammatory and pro-atherothrombotic pathways. Hypoglycemia has been reported to influence the development of preclinical atherosclerosis. The present study was designed to prospectively evaluate whether hypoglycemia influences the function and the morphology of the arteries in subjects with type 2 diabetes without complications and uncontrolled diabetes. Seventy-six subjects underwent a noninvasive evaluation of carotid wall thickness and brachial artery function at baseline and after one year of treatment with the intent of obtaining optimal glycemic control. At the end of the observation time, subjects were divided in two groups: with hypoglycemia (H-group) or without hypoglycemia (C-group). Baseline characteristic were comparable between groups. HbA1c significantly decreased in both groups, and fasting plasma glucose was only significant in the H-group. Subjects with hypoglycemia showed a significant reduction of carotid wall thickness after one-year of treatment (H-groups: right baseline 834±141 vs. 1-year 770±132 μ p<0.05; C-group: 757±162 vs. 767±135 μ p = ns). Endothelial function remained unchanged during the study for both groups. The present findings demonstrate that hypoglycemia does not affect endothelial function. Furthermore, subjects who experience more hypoglycemia show significant reduction of carotid wall thickness. Optimal metabolic control should be pursued as soon as possible.