Seven day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study

TY - JOUR

T1 - Seven day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus

T2 - a randomised pilot study

AU - Maxwell, Joseph D

AU - Carter, Howard Henry

AU - Hellsten, Ylva

AU - Miller, Gemma D

AU - Sprung, Victoria S

AU - Cuthbertson, Daniel J

AU - Thijssen, Dick H J

AU - Jones, Helen

N1 - CURIS 2019 NEXS 371

PY - 2019

Y1 - 2019

N2 - Background: Remote ischaemic preconditioning (rIPC) may improve cardiac/ce rebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a b out of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. Th e aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention. Methods: Twenty-one patients with T2DM were randomly allocated to eithe r 7-day daily upper-arm rIPC (4 ×5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We exam ined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusi on injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention. Results: For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95% C I: 0.69 to 3.80; P = 0.09) and 0.23 %cm/s %/mmHg mmHg/% (-0.12, 0.59; P = 0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each gr oup would provide 90% power to detect statistically significant (P < 0.05) between-group difference in a randomised controlled trial . Conclusion: We provide estimates of sample size for a randomised control t rial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.

AB - Background: Remote ischaemic preconditioning (rIPC) may improve cardiac/ce rebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a b out of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. Th e aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention. Methods: Twenty-one patients with T2DM were randomly allocated to eithe r 7-day daily upper-arm rIPC (4 ×5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We exam ined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusi on injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention. Results: For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95% C I: 0.69 to 3.80; P = 0.09) and 0.23 %cm/s %/mmHg mmHg/% (-0.12, 0.59; P = 0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each gr oup would provide 90% power to detect statistically significant (P < 0.05) between-group difference in a randomised controlled trial . Conclusion: We provide estimates of sample size for a randomised control t rial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.

KW - Faculty of Science

KW - Remote ischaemic preconditioning

KW - Type 2 diabetes

KW - Vascular function

KW - Ischaemia reperfusion injury

U2 - 10.1530/eje-19-0378

DO - 10.1530/eje-19-0378

M3 - Journal article

C2 - 31614332

SN - 0804-4643

VL - 181

SP - 659

EP - 669

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 6

ER -