Journal Article Ppublish 1 citation
PubMed: 38491968 DOI: 10.1210/clinem/dgae152
Impact of Insulin-Induced Relative Hypoglycemia on Vascular Insulin Sensitivity and Central Hemodynamics in Prediabetes.
J Clin Endocrinol Metab 110(2):e423-e431
Authors: Daniel J Battillo, Mary-Margaret E Remchak, Ankit M Shah, Steven K Malin
Affiliations
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ 08901, USA.
- Division of Endocrinology, Metabolism & Nutrition; Rutgers University, New Brunswick, NJ 08901, USA.
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ 08901, USA.
- Institute of Translational Medicine and Science, Rutgers University, New Brunswick, NJ 08901, USA.
Abstract
CONTEXT
Relative hypoglycemia (RH) is linked to sympathetic responses that can alter vascular function in individuals with type 2 diabetes. However, less is known about the role of RH on hemodynamics or metabolic insulin sensitivity in prediabetes.
OBJECTIVE
Determine if RH alters peripheral endothelial function or central hemodynamics to a greater extent in those with prediabetes vs normoglycemia.
METHODS
Seventy adults with obesity were classified using ADA criteria as prediabetes (n = 34 (28 F); HbA1c = 6.02% ± 0.1%) or normoglycemia (n = 36 (30 F); HbA1c = 5.4% ± 0.0%). Brachial artery endothelial function, skeletal muscle capillary perfusion, and aortic waveforms were assessed at 0 and 120 minutes of a euglycemic clamp (40 mU/m2/min, 90 mg/dL). Plasma nitrate/nitrite and endothelin-1 were measured as surrogates of nitric oxide-mediated vasodilation and vasoconstriction, respectively. RH was defined as the drop in glucose (%) from fasting to clamp steady state.
RESULTS
There were no differences in age, weight, or VO2max between groups. The prediabetes group had higher HbA1c (P < .01) and a greater drop in glucose in response to insulin (14% vs 8%; P = .03). Further, heart rate increased in normoglycemia compared to prediabetes (P < .01), while forward wave (Pf) decreased in prediabetes (P = .04). Insulin also tended to reduce arterial stiffness in normoglycemia vs prediabetes (P = .07), despite similar increases in preocclusion diameter (P = .02), blood flow (P = .02), and lower augmentation index (P ≤ .05).
CONCLUSION
Compared with normoglycemia, insulin-induced RH corresponded with a blunted rise in heart rate and drop in Pf during insulin infusion in adults with prediabetes, independent of changes in peripheral endothelial function.
MeSH
Diabetes Mellitus, Endocrinology, Insulin, Heart Rate, Heart, Prediabetic State, Hypoglycemia, Hemodynamics