Arterial stiffness and vascular complications in patients with type 1 diabetes: The Finnish Diabetic Nephropathy (FinnDiane) Study

Figures & data

Table I. Clinical characteristics of patients with type 1 diabetes versus non-diabetic controls.

		Patients with type 1 diabetes
	Non-diabetic controls (n = 185)	Normoalbuminuria (n = 401)	Microalbuminuria (n = 67)	Macroalbuminuria (n = 89)	Overall P value
Gender (% males)	43.8	46.7	41.8	52.9	0.45
Age (years)	41.6 ± 1.2	40.5 ± 0.9	43.8 ± 2.0	45.5 ± 1.5	<0.001
Duration (years)	–	24.7 ± 0.7	31.3 ± 1.6^c	33.5 ± 1.1	<0.001
Height (cm)	172 ± 1	170 ± 1	166 ± 3	169 ± 2	0.68
BMI (kg/m^2)	24.2 ± 0.3	26.3 ± 9.7^b	26.7 ± 1.3	25.8 ± 0.5	0.73
HbA1c (%)	5.6 ± 0.0	8.2 ± 0.1^a	8.5 ± 0.2	8.4 ± 0.2	0.61
Serum total cholesterol (mmol/L)	4.8 ± 0.1	4.5 ± 1.0 a	4.7 ± 1.2	4.5 ± 1.0	0.74
Serum triglycerides (mmol/L)	0.9 (0.70–1.27)	0.8 (0.7–1.2)	1.3 (0.8 – 1.6)^d	1.5 (1.0–1.8)	<0.001
Serum creatinine (μmol/L)	69 ± 2.2	81 ± 2^b	88 ± 11	85 ± 4	0.38
Urinary albumin excretion rate (μ g/min versus mg/24 h)	1 (0–3)	2 (1–6)	68 (20–82)	461 (40 – 490)	–
Serum CRP (mg/L)	2.3 ± 0.4	3.7 ± 0.4^a	4.8 ± 1.3	5.5 ± 1.1	0.29
Brachial SBP (mmHg)	130 ± 1	133 ± 1	134 ± 3	150 ± 3^e	<0.001
Brachial DBP (mmHg)	77 ± 1	73 ± 1^b	73 ± 2	76 ± 2	0.60
Brachial PP (mmHg)	53 ± 1	60 ± 1^a	66 ± 2^d	74 ± 2^f	<0.001
Current smoker (%)	13.8	14.7	27.4	20.7	0.10
Antihypertensive treatment (%)	9.3	33.4^a	80.3	95.5	<0.001
CVD (%)	1.6	5.0^b	16.4^d	32.6	<0.001
Retinal laser treatment (%)	–	16.3^a	56.7	83.1	–

Data are mean ± SEM, median (interquartile range), or %.

^aP < 0.001; ^bP < 0.05 for normoalbuminuria compared to healthy controls.

^cP < 0.001; ^dP < 0.05 for microalbuminuria compared to normoalbuminuria.

^eP < 0.001; ^fP < 0.05 for macroalbuminuria compared to microalbuminuria.

BMI = body mass index; CRP = C-reactive protein; SBP = systolic blood pressure; DBP = diastolic blood pressure; PP = pulse pressure; CVD = cardiovascular disease.

Table II. Indices of arterial stiffness in patients with type 1 diabetes versus non-diabetic controls.

		Patients with type 1 diabetes
	Non-diabetic controls	Normoalbuminuria	Microalbuminuria	Macroalbuminuria	Overall P value
Aortic SBP (mmHg)	116 ± 1	121 ± 1^b	124 ± 2	138 ± 3^e	<0.001
Aortic DBP (mmHg)	78 ± 1	78 ± 0	78 ± 1	82 ± 1^f	0.18
Aortic PP (mmHg)	39 ± 1	44 ± 1^b	46 ± 3	57 ± 2^e	0.001
AIx (%)	10.0 ± 1.2	17.3 ± 0.6^a	20.7 ± 0.8^d	25.9 ± 1.0^f	<0.001
HR (bpm)	61 ± 1	68 ± 2^a	72 ± 2	70 ± 1	0.92
Tr (ms)	154 ± 2	144 ± 1^a	138 ± 2^d	135 ± 1	<0.001
SEVR (%)	169 ± 2	148 ± 2^a	128 ± 4^c	125 ± 3	<0.001

Data are mean ± SEM.

^aP < 0.001; ^bP < 0.05 for normoalbuminuria compared to healthy controls.

^cP < 0.001; ^dP < 0.05 for microalbuminuria compared to normoalbuminuria.

^eP < 0.001; ^fP < 0.05 for macroalbuminuria compared to microalbuminuria.

SBP = systolic blood pressure; DBP = diastolic blood pressure; PP = pulse pressure; AIx = augmentation index; HR = heart rate; Tr = time to return of reflected wave; SEVR = subendocardial viability ratio.

Figure 1. AIx by albuminuria status in patients with type 1 diabetes.

Table III. Multivariate logistic regression analysis of patients with type 1 diabetes with diabetic nephropathy and diabetic retinopathy (normoalbuminuric patients) as dependent variables.

	AIx OR (95% CI); P value	Aortic PP OR (95% CI); P value	Brachial PP OR (95% CI); P value
Diabetic nephropathy:
Model 1	1.06 (1.04–1.09); P < 0.001	1.03 (1.02–1.05); P < 0.001	1.04 (1.02–1.05); P < 0.001
Model 2	1.04 (1.02–1.07); P = 0.001	0.98 (0.98–1.04); P = 0.86	0.99 (0.97–1.03); P = 0.89
Model 3	1.04 (1.01–1.08); P = 0.004	1.01 (0.98–1.04); P = 0.69	0.99 (0.97–1.03); P = 0.97
Model 4	1.03 (1.00–1.06); P = 0.044	0.98 (0.95–1.02); P = 0.26	0.99 (0.96–1.02); P = 0.44
Diabetic retinopathy:
Model 1	1.10 (1.06–1.14); P < 0.001	1.05 (1.03–1.07); P < 0.001	1.04 (1.02–1.06); P < 0.001
Model 2	1.09 (1.05–1.14); P < 0.001	1.05 (1.01–1.10); P = 0.008	1.03 (0.99–1.07); P = 0.14
Model 3	1.08 (1.03–1.13); P = 0.002	1.03 (0.98–1.08); P = 0.31	1.03 (0.99–1.07); P = 0.18
Model 4	1.06 (1.01–1.12); P = 0.025	0.97 (0.91–1.03); P = 0.35	1.01 (0.97–1.07); P = 0.57

Model 1 adjusted for age, height, and gender.

Model 2 adjusted for age, height, gender, brachial SBP, and HbA_1c.

Model 3 adjusted for age, height, gender, brachial SBP, HbA_1c, triglycerides, and current smoking.

Model 4 adjusted for age, duration of diabetes, height, gender, brachial SBP, HbA_1c, triglycerides, presence of CVD, and current smoking.

Figure 2. AIx in subjects with type 1 diabetes and normal urinary albumin excretion rate with and without laser treatment.

Table IV. Multivariate logistic regression analysis of patients with type 1 diabetes with cardiovascular disease as dependent variable.

	AIx OR (95% CI); P value	Aortic PP OR (95% CI); P value	Brachial PP OR (95% CI); P value
Model 1	1.10 (1.05–1.15); P < 0.001	1.06 (1.04–1.09); P < 0.001	1.05 (1.03–1.07); P < 0.001
Model 2	1.07 (1.02 – 1.11); P = 0.006	1.09 (1.05–1.14); P < 0.001	1.04 (1.00–1.08); P = 0.04
Model 3	1.06 (1.00–1.12); P = 0.01	1.11 (1.06–1.16); P < 0.001	1.04 (1.00–1.09); P = 0.045
Model 4	1.04 (0.99–1.09); P = 0.129	1.07 (1.03–1.12); P = 0.003	1.02 (0.98–1.06); P = 0.352

Model 1 adjusted for duration of diabetes, height, and gender.

Model 2 adjusted for duration of diabetes, height, gender, brachial SBP, and HbA_1c.

Model 3 adjusted for duration of diabetes, height, gender, brachial SBP, HbA_1c, total cholesterol, current smoking, and diabetic nephropathy.

Model 4 adjusted for age, duration of diabetes, height, gender, brachial SBP, HbA_1c, total cholesterol, current smoking, and diabetic nephropathy.