Increased intimal-medial thickness in newly detected type 2 diabetes - Risk factors

OBJECTIVE - To examine carotid intimal-medial thickness (IMT) and its deter minants in newly detected type 2 diabetic subjects, classified according to the new criteria of the American Diabetes Association, in comparison with age- and sex-matched control subjects with normal glucose tolerance. RESEARCH DESIGN AND METHODS - This study was case-controlled with matched p airs for 71 newly diagnosed type 2 diabetic individuals. Subjects aged 40-7 0 years were recruited from a risk population for diabetes seen in the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) Study Standard risk factors, 75-g oral glucose tolerance test with real insulin, proinsulin, a nd C-peptide, and ultrasound measurement of the IMT of the common carotid a rtery were performed. RESULTS - The diabetic subjects, both men and women, displayed carotid inti mal-medial thickening, even in the subgroup with fasting plasma glucose bet ween 7.0 and 7.8 mmol/l. HbA(1c) was significantly increased in the diabeti c patients (6.33 vs. 5.48%). Insulin, proinsulin, and C-peptide were also s ignificantly higher. Among the coronary risk factors, triglycerides and pla sminogen activator inhibitor were significantly increased. After age and se x adjustment, IMT in the diabetic group was correlated to triglycerides and the total-to-HDL cholesterol ratio. In the total group, IMT was significan tly correlated to blood pressure, 2-h glucose in oral glucose tolerance tes ting, triglycerides, albuminuria, and the total-to-HDL cholesterol ratio, a nd inversely correlated to HDL cholesterol. No independent determinant of I MT was found in the diabetic group by multivariate analysis. CONCLUSIONS - Newly detected type 2 diabetic patients exhibit a higher degr ee of early atherosclerosis than normal glucose-tolerant subjects matched f or age and sex. Our data suggest that hyperglycemia, together with a cluste ring of risk factors, and in particular dyslipidemia, may cause intimal-med ial thickening in the early phases of diabetes.