Acute hyperglycemia reduces cerebrovascular reactivity: The role of glycemic variability

Ilaria Giordani, Alessandra Di Flaviani, Fabiana Picconi, Ilaria Malandrucco, Dorina Ylli, Paola Palazzo, Riccardo Altavilla, Fabrizio Vernieri, Francesco Passarelli, Silvia Donno, Davide Lauro, Patrizio Pasqualetti, Simona Frontoni

Research output: Contribution to journalArticle

Abstract

Context: Cerebral vasomotor reactivity (CVR) is reduced in patients with diabetes mellitus (DM), and glucose variability (GV) might be responsible for cerebrovascular damage. Objective: Studying patients with insulin resistance without DM, we explored the role of GV in impairing CVR. Patients: We studied 18 metabolic syndrome (MS) patients without DM, 9 controls (C), and 26 patients with DM. Main Outcome Measures: Groups were compared in terms of CVR, GV, and 24-hour blood pressure. To evaluate the impact of acute hyperglycemia on CVR, a hyperglycemic clamp was performed in MS patients and controls. Results: Baseline CVR was reduced inDMvs C and MS (C vsDM=20.2, 95% CI=3.5-36.9, P=.014; and MS vs DM = 22.2, 95% CI = 8.6 -35.8, P = .001), but similar between MS and C (MS vs C = 2.0, 95% CI = -14.7 to 18.7, P = .643). During acute hyperglycemia, CVR fell in MS and C to values comparable to DM. GV progressively increased from C toMS to DM. In MS, CVR at 120 minutes and GV displayed a negative correlation (r=-0.48, P = .043), which did not change after controlling for mean 24-hour systolic and diastolic blood pressure. In MS, the CVR reduction was significantly correlated to GV (r = 0.55, P = .02). Conclusions: GV is increased in patients with MS but withoutDMand is the major predictor of CVR reduction induced by acute hyperglycemia, possibly representing the earliest cause of cerebrovascular damage in DM.

Original languageEnglish
Pages (from-to)2854-2860
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number8
DOIs
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

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    Giordani, I., Di Flaviani, A., Picconi, F., Malandrucco, I., Ylli, D., Palazzo, P., Altavilla, R., Vernieri, F., Passarelli, F., Donno, S., Lauro, D., Pasqualetti, P., & Frontoni, S. (2014). Acute hyperglycemia reduces cerebrovascular reactivity: The role of glycemic variability. Journal of Clinical Endocrinology and Metabolism, 99(8), 2854-2860. https://doi.org/10.1210/jc.2014-1087