Vascular endothelial dysfunction in patients with newly diagnosed type 2 diabetes and effects of 2-year and 5-year multifactorial intervention.
OBJECTIVES
Investigate short- and long-term effect of multifactorial intervention on endothelial dysfunction in patients with newly diagnosed type 2 diabetes.


BACKGROUND
Whether multifactorial intervention reduces cardiovascular risk in type 2 diabetes is largely controversial, partially because of lack of reliable method for endothelial dysfunction detection. Using high-resolution ultrasonographical flow-mediated vasodilatation (FMD), we completed a 5-year randomized prospective intervention trial in patients with newly diagnosed type 2 diabetes. We have studied the effect of multifactorial intervention therapy on their endothelial dysfunction.


METHODS
One hundred eight patients with newly diagnosed type 2 diabetes, and 83 healthy subjects received measurement of brachial artery FMD and endothelium-independent dilatation (EID). Diabetic patients were assigned into four groups, treated with: (A) hypoglycemic and antihypertensive agents, (B) hypoglycemic, antihypertensive and lipid-lowering agents, (C) hypoglycemic, antihypertensive and lipid-lowering agents, and vitamin E, and (D) hypoglycemic, antihypertensive and lipid-lowering agents, and compound salvia tablets. Both FMD and EID were remeasured after 24- and 60-month treatment.


RESULTS
FMD in diabetic patients was significantly lower than those in healthy subjects. After 24-month treatment, there was no FMD change. However, FMD improved significantly after 60-month treatment. The differences between 24- and 60-month are also significant. EID did not change significantly after both 24- and 60-month treatments.


CONCLUSIONS
(1) FMD-detectable endothelial dysfunction exists in newly diagnosed type 2 diabetic patients. (2) Reverse of endothelial function occurs only after long-term (60-month) multifactorial intervention. (3) FMD could potentially help early identification, stratification, and treatment of endothelial dysfunction in type 2 diabetic patients.