DISSOCIATION OF MICROANGIOPATHY AND MACROANGIOPATHY IN PATIENTS WITH TYPE-2 DIABETES

OBJECTIVE - Although persistent hyperglycemia contributes greatly to t he progression of diabetic micro- and macroangiopathy, microangiopathy progresses more rapidly than macroangiopathy in some type 2 diabetic patients, with the opposite being true in others. This study was condu cted to identify factors responsible for such dissociation. RESEARCH D ESIGN AND METHODS - Patients with proliferative diabetic retinopathy a nd a carotid intima-media thickness (IMT) level less than or equal to 1.0 mm were classified as the microangiopathy group (MIG); those with an IMT level >1.1 mm and without retinopathy or with background retino pathy were assigned to the macroangiopathy group (MAG). Only middle-ag ed patients, 50-69 years old, were included in this study. There were 54 patients in the MIG and 68 patients in the MAG. RESULTS - Patients in the MIG were significantly younger at the onset of diabetes, and th ose in the MAG had a significantly higher mean ratio of apoprotein (ap o) B to apoAI. The percent age of patients with a family history of di abetes was significantly higher in the MIG. Maternal inheritance was c ommon among these patients. Those with obesity a family history of dia betes, and younger onset of hypertension were more common in the MAG. In the multiple logistic regression analyses, maternal inheritance and early onset of diabetes were independent risk factors for the acceler ation of microangiopathy. A personal history of obesity and a family h istory of hypertension were independently related to the development o f macroangiopathy. CONCLUSIONS - Our results suggest that patients wit h early onset and maternal inheritance of diabetes may have a high ris k for the progression of diabetic microangiopathy, while patients with hyperlipidemia, a history of obesity, and a family history of hyperte nsion seem prone to the development of atherosclerosis.