Evaluation of the relationship between microvascular complications and carotid intima-media thickness and endothelial functions in patients with type 2 diabetes mellitus with poor glycemic control

Objective. There have been contradictory results in the studies evaluating the relationship between microvascular complications and endothelial functions in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the relationship between microvascular complications and, carotid intima-media thickness (CIMT) and endothelial functions evaluated by flow mediated dilatation (FMD) in patients with T2DM, who were subject to initiate insulin therapy because of poor glycemic control.Material and Method. 40 patients with T2DM with a mean age of 57.2 ? 10.8 years and 25 healthy control subjects with a mean age of 54.1±9.6 years were included in the study. FMD and CIMT were measured in all patients using high resolution ultrasonography. The patients were evaluted in terms of microvascular complications and, clinical and demographic features were recorded.Results. The mean duration of the disease was 89.9±90.9 (0-360) months and the mean percentage of HbA1c was 10.12±1.2% in the diabetic patients. Retinopathy was detected in 27.5%, neuropathy in 57.5%, microalbuminuria in 60% and macroalbuminuria in 40% of the patients. CIMT was detected significantly higher in diabetic patients, when compared with the control subjects. The percentage value of FMD was detected significantly lower in the diabetic group. The correlation analysis of the diabetic patients revealed that the frequency of the complications was negatively correlated with FMD and, positively correlated with CIMT, the duration of diabetes and age.Conclusion. We found an impairment in endothelial functions and an increase in CIMT and, a significant correlation between these parameters and microvascular complicattions in diabetic patients, who were subject to initiate insulin therapy because of poor glycemic control. This finding suggests that diabetic microangiopathy and macroangiopathy are related to each other in a paralel way.Key Words: Type 2 diabetes mellitus, endothelial dysfunction, carotid intima-media thickness