Background: Achievement of blood pressure (BP) control is an important target in type 2 diabetic patients (T2DM) to prevent microvascular and macrovascular complication. T2DM patients are characterized by endothelial dysfunction, which represents a key mechanism for the development of atherosclerotic disease. Aim: The aim of this study is to evaluate the effect of a nutritional and dietary counseling on BP control and endothelial dysfunction in T2DM. Materials and methods: Nineteen T2DM patients (age 61 ± 5 years, 4 females) were provided of a by a 2-day 24 hour dietary recall at 1, 3, 6, 9 and 12 months. BP, endotheliumdependent (flow-mediated dilation, FMD, after 5-minute of forearm ischemia) and independent (sublingual glycerol trinitrate, GTN, 25 lg) vasodilation by high resolution ultrasounds and computerized analysis of brachial artery diameter (maximal % increase) were assessed at baseline and after 12 months. Twenty age and gender matched healthy subjects were recruited as controls. Results: At baseline T2DM had significantly (P < 0Æ01) lower FMD (4Æ3 ± 1Æ9%) and FMD/GTN ratio (0Æ61 ± 0Æ15) as compared to controls (6Æ9 ± 2Æ1% and 0Æ91 ± 0Æ22, respectively). Response to GTN was similar in T2DM (7Æ8 ± 2Æ4%) and controls (7Æ6 ± 3Æ0%). After 12 months, there was a significant (P < 0Æ01) reduction in systolic BP (from 145 ± 17 to 133 ± 8 mmHg) and a not significant reduction in diastolic BP (from 85 ± 12 to 78 ± 9 mmHg, P = 0Æ06), HbA1c (from 7Æ7 ± 17 to 7Æ1 ± 0Æ8%, P = 0Æ18) and plasma folate (from 6Æ1 ± 8Æ4 to 11Æ4 ± 8Æ5 mg mL)1, P < 0Æ001). Number or dosage of antihypertensive drugs was increase in 25% of the patients. FMD (5Æ9 ± 2Æ9%) and FMD/GTN ratio (0Æ84 ± 0Æ61), but not response to GTN (7Æ4 ± 1Æ7%) were also significantly (P < 0Æ05) improved. However, the improvement in FMD and FMD/ GTN ratio was not related to changes in BP, metabolic control, plasma folate concentration or pharmacological treatment, but to sodium excretion reduction exclusively (r = 0Æ51, P < 0Æ005). Conclusions: A long term nutritional and dietary counseling have positive effect on dietary behavior of T2DM patients resulting in a significant better BP control and an improvement of endothelial dysfunction.
Type 2 diabetes: blood pressure control and endothelial function are influenced by nutritional educational program
GIAMPIETRO, OTTAVIO;MATTEUCCI, ELENA
2010-01-01
Abstract
Background: Achievement of blood pressure (BP) control is an important target in type 2 diabetic patients (T2DM) to prevent microvascular and macrovascular complication. T2DM patients are characterized by endothelial dysfunction, which represents a key mechanism for the development of atherosclerotic disease. Aim: The aim of this study is to evaluate the effect of a nutritional and dietary counseling on BP control and endothelial dysfunction in T2DM. Materials and methods: Nineteen T2DM patients (age 61 ± 5 years, 4 females) were provided of a by a 2-day 24 hour dietary recall at 1, 3, 6, 9 and 12 months. BP, endotheliumdependent (flow-mediated dilation, FMD, after 5-minute of forearm ischemia) and independent (sublingual glycerol trinitrate, GTN, 25 lg) vasodilation by high resolution ultrasounds and computerized analysis of brachial artery diameter (maximal % increase) were assessed at baseline and after 12 months. Twenty age and gender matched healthy subjects were recruited as controls. Results: At baseline T2DM had significantly (P < 0Æ01) lower FMD (4Æ3 ± 1Æ9%) and FMD/GTN ratio (0Æ61 ± 0Æ15) as compared to controls (6Æ9 ± 2Æ1% and 0Æ91 ± 0Æ22, respectively). Response to GTN was similar in T2DM (7Æ8 ± 2Æ4%) and controls (7Æ6 ± 3Æ0%). After 12 months, there was a significant (P < 0Æ01) reduction in systolic BP (from 145 ± 17 to 133 ± 8 mmHg) and a not significant reduction in diastolic BP (from 85 ± 12 to 78 ± 9 mmHg, P = 0Æ06), HbA1c (from 7Æ7 ± 17 to 7Æ1 ± 0Æ8%, P = 0Æ18) and plasma folate (from 6Æ1 ± 8Æ4 to 11Æ4 ± 8Æ5 mg mL)1, P < 0Æ001). Number or dosage of antihypertensive drugs was increase in 25% of the patients. FMD (5Æ9 ± 2Æ9%) and FMD/GTN ratio (0Æ84 ± 0Æ61), but not response to GTN (7Æ4 ± 1Æ7%) were also significantly (P < 0Æ05) improved. However, the improvement in FMD and FMD/ GTN ratio was not related to changes in BP, metabolic control, plasma folate concentration or pharmacological treatment, but to sodium excretion reduction exclusively (r = 0Æ51, P < 0Æ005). Conclusions: A long term nutritional and dietary counseling have positive effect on dietary behavior of T2DM patients resulting in a significant better BP control and an improvement of endothelial dysfunction.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
