Evaluation of Vascular Resistance in the Cerebral Arteries in Patients with Diabetes Mellitus type 1 J. Nealis 1 , M.A. Pawlak 1 , A. Uruska 2 , J. Ziółkiewicz 1 , D.A. Zozulińska 2 , R. Kaźmierski 1 1. Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, MSWiA Hospital, Poznan Poland 2. Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Poznan, Poland Introduction Diabete Mellitus type 1 (DM1) is a chronic disease that varies from person to person. The gold standard of treatment is daily glucose measurements and intensive insulin therapy. These patients are constantly at risk for health complications had they fail to comply with those requirements. It is tedious, stressful and can lead to complications that can lead them to debilitating lives or even death. Diabetes plays a major role in affecting the body's blood vessels through enzymatic glycolysation of intra and extracellular proteins, which accelerates atherosclerosis and changes the physiological blood flow in arteries by making them harder and stiffer 1 . An important marker to track long term glucose levels is glycated hemoglobin (HbA1c). It is a form of hemeglobin that indicates the average glucose plasma concentration over a three month period. Patients suffering from diabetes have a threefold risk for cerebrovascular disease compared to non- diabetics. 2 . Ischemic stroke is a major complication of diabetes. Compared with healthy people, patients with DM show more extensive atherosclerosis of extracranial and intracranial vessels 3 . Atherosclerosis can lead to microangiopathic defects within the small arteries of the brain which can lead to lacunar infarcts. Lacunar infarcts can progress to vascular dementia which causes a progressive decline in cognitive function. 4 . Aim of this study To evaluate the validity of measures of cerebrovascular resistance as markers of cerebral vessel damage in the course of diabetes mellitus type 1. This is achievable by measuring the spectrum of cerebral arterial flow in patients with diabetes mellitus type 1 and to compare their HbA1c levels as well as other biochemical markers to assess their risk for cerebrovascular complications. Methods Measured: -Pulsatility Index (PI) -Resistance Index (PI) -Time to Peak (TTP) -Peak to Peak (Peak-Peak) Transcranial color coded Doppler ultrasound scanner Siemens Acuson Antares - 1-4 Mhz convex probe Arteries Measured: Anterior Cerebral Artery Middle Cerebral Artery Posterior Cerebral Artery Results Conclusion Acknowledgment References 1. Kwater A, Gasowski J, Gryglewska B, Wizner B, Grodzicki T. Is blood flow in the middle cerebral artery determined by systemic arterial stiffness? Blood Press. 2009;18(3):130-4 2. Park JS, Cho MH, Lee KY, Kim CS, Kim HJ, Nam JS, Ahn CW,Cha BS, Lee EJ, Lim SK, Kim KR, Lee HC,.. Cerebral arterial pulsatility and insulin resistance in type 2 diabetic patients. Diabetes Res Clin Pract. 2008 Feb;79 (2):237 -42 3.Kyung Y. Lee, Young H. Sohn, Jong S. Baik, Gyung W. Kim and Jin Soo Kim. Arterial Pulsatility as an Index of Cerebral Microangiopathy in Diabetes,Stroke 2000;31;1111- 1115 4. Petrica L, Petrica M, Munteanu M, Vlad A, Bob F, Gluhovschi C, Gluhovschi G, Jianu C, Schiller A, Velciov S, Trandafirescu V, Bozdog G. Cerebral microangiopathy in patients with non-insulin dependant diabetes mellitus. Ann Acad Med Singapore. 2007 Apr;36(4):259-66 5. Vlassera H: Recent progress on the biologic and clinical significance of advanced glycosylation end products. J Lab Clin Med 1994; 124:19-30 We are grateful for the collaboration with the department of internal medicine and diabetology led by Professor Zozulinska and Dr. Uruska. We thank the patients for their time and participating in the study. p= 0.019 p=0.0005 p=0.0024 p=0.0089 p=0.0178 Our research shows that diabetes mellitus disease duration has an effect on Left MCA resistance (p= 0.0024) and pulsatility indexes (p= 0.0005), Left ACA time to peak (p= 0.019) and right ACA resistance indexes (p= 0.0089). Advanced Glycation end products (AGE) has an effect on right ACA resistance indexes (p=0.0178). Changes in HbA1c did not influence resistance indexes of any artery. Our patients have adequate treatment, follow up and DM complications are treated immediately and appropriately. The HbA1c have been either within normal limits or slighting increased. If we have had poorly treated DM HbA1c would have been higher. Our patients are receiving excellent medical care. Our patients are relatively young, median age of 37 years old. Their disease duration is also relatively short of 10 years +/- 1.7 years. The effect of advanced glycation end products (AGEs) on the right ACA resistance could be explained by the fact that we have 11 patients suffering from diabetic retinopathy. AGEs play a role in the pathogenesis of diabetes mellitus 5 Our study shows the importance of the transcranial Doppler ultrasound in that it can effectively and quickly visualize cerebral vessels and analyze them for abnormalities. The transcranial ultrasound, is cheap, portable, and has a short learning curve. Its major drawback is that its dependent on the operator’s skills. * * HbA1c <7% normal for DM Patients View publication stats View publication stats