Carotid intima-media thickness among normoglycemia and normotension first-degree relatives of type 2 diabetes mellitus

Vascular Health and Risk Management Dovepress open access to scientific and medical research Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 119.30.245.221 on 26-May-2020 For personal use only. Open Access Full Text Article Carotid intima-media thickness among normoglycemia and normotension first-degree relatives of type 2 diabetes mellitus This article was published in the following Dove Press journal: Vascular Health and Risk Management Dyah Purnamasari 1 Muhammad Syah Abdaly 2 Mohamad Syahrir Azizi 3 Ika Prasetya Wijaya 3 Pringgodigdo Nugroho 4 1 Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; 2Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; 3Division of Cardiology, Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; 4Division of Nephrology, Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia Introduction: Theoretically, first-degree relatives (FDRs) of type 2 diabetes mellitus (T2DM) are predisposed to have earlier and more severe atherosclerosis than non-FDR due to hereditary insulin resistance. A previous study reported that atherosclerotic plaques were found in 45.2% of young adults FDR of T2DM, but the study did not include non-FDR as control group. The aim of this study was to compare subclinical atherosclerosis (carotid intima-media thickness, CIMT) between FDR of T2DM and non-FDR. Method: This was a cross-sectional study involving 16 FDR subjects and 16 age-sex matched non-FDR subjects, aged 19–40 years, with normal glucose tolerance and no hypertension. Collected data included demographic characteristic, anthropometric measurement (BMI and waist circumference), laboratory analysis (fasting blood glucose, HbA1c, lipid profile), and CIMT examination (using B-mode ultrasound). Results: The mean of CIMT in the FDR group was higher than that in the non-FDR group (0.44 mm vs 0.38 mm, p=0.005). After adjusting for waist circumference, BMI, low-density lipoprotein cholesterol, and triglyceride, CIMT maintained significant difference between FDR and nonFDR subjects. BMI and waist circumference showed moderate correlation with CIMT. Conclusion: CIMT in young adult FDR of T2DM is thicker than that in age-and sexmatched non-FDR population. Keywords: first-degree relatives, type 2 diabetes mellitus, subclinical atherosclerosis, carotid intima-media thickness Introduction Correspondence: Dyah Purnamasari Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Salemba Raya 6, Jakarta10430, Indonesia Email Cardiovascular disease (CVD) remains a leading cause of death globally. Recent data in 2013 showed that approximately 17.3 million of the total 54 million deaths per year in the world were caused by CVD.1 According to WHO data in 2014, CVD is the leading cause of death in Indonesia, comprising 37% of all causes of death.2 Atherosclerosis is a major underlying cause of CVD, including myocardial infarction, stroke, heart failure, and peripheral artery disease. This condition begins early in childhood and is progressive. Atherosclerosis is often asymptomatic for several decades before manifesting clinically, termed as subclinical atherosclerosis.3,4 Cardiovascular risk factors such as hypertension, hyperglycemia, dyslipidemia, and obesity not only play a role in the development of the atherosclerosis process, but also serve as components of insulin-resistance syndrome.5 101 submit your manuscript | www.dovepress.com Vascular Health and Risk Management 2019:15 101–107 DovePress © 2019 Purnamasari et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/ terms.php and incorporate the Creative Commons Attribution– Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://doi.org/10.2147/VHRM.S195776 Powered by TCPDF (www.tcpdf.org) ORIGINAL RESEARCH Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 119.30.245.221 on 26-May-2020 For personal use only. Purnamasari et al One of the risk factors for developing insulin resistance is first-degree relatives (FDRs) who suffer from type 2 diabetes mellitus (T2DM). The FDR group shows the tendency of insulin resistance and pancreatic beta cell function impairment, even in adolescence.6 A study showed that normoglycemic FDR of T2DM patients had higher insulin levels, more fat accumulation in muscle, and lower peripheral glucose uptake than in the non-FDR population.7 The insulin-resistance FDR group also proved to have impaired coronary artery blood flow and coronary elasticity.8 A previous study in Indonesia showed that atherosclerotic lesions were found in 45.2% normoglycemic and normotensive young adults from FDR population.9 However, the study did not include the nonFDR group; therefore, the difference in subclinical atherosclerotic lesions between the two groups was unknown. Method This study was conducted between June and September 2018, involving 16 subjects of FDR T2DM and 16 subjects with non-FDR T2DM, who were matched for age and gender. Sample collection was performed using consecutive sampling method. The FDR subjects were recruited through direct invitation by diagnosed T2DM patients of the Endocrinology Outpatient Clinic at Cipto Mangunkusumo National General Hospital (RSCM). Consecutively, all T2DM patients were asked to allow their offsprings to participate in the study. All of the candidates were given information regarding the study and were screened based on the study criterion. Informed consent was obtained from those who fulfilled the criteria. Other inclusion criteria for the FDR group included men and women aged 19–40 years and who were normoglycemic and normotensive (HbA1c <5.7%, blood pressure <140/90 mmHg). For the control group, we recruited nonmedical workers at RSCM, who did not have a family history of T2DM and had similar inclusion criteria with that of the FDR group. Exclusion criteria for both groups were as follows: 1) smoking; 2) history of coronary heart disease, heart failure, arrhythmia, anemia, stroke, transient ischemic attack, peripheral arterial disease, history of hypertension, and diabetes mellitus; 3) taking hypertensi (...truncated)