TY - JOUR

T1 - Seven day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus

T2 - a randomised pilot study

AU - Maxwell, Joseph D

AU - Carter, Howard Henry

AU - Hellsten, Ylva

AU - Miller, Gemma D

AU - Sprung, Victoria S

AU - Cuthbertson, Daniel J

AU - Thijssen, Dick H J

AU - Jones, Helen

N1 - CURIS 2019 NEXS 371

PY - 2019

Y1 - 2019

N2 - Background: Remote ischaemic preconditioning (rIPC) may improve cardiac/cerebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a bout of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. The aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention.Methods: Twenty-one patients with T2DM were randomly allocated to either 7-day daily upper-arm rIPC (4x5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We examined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusion injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention.Results: For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95%CI: 0.69 to 3.80; P=0.09) and 0.23 %cm s-1 %.mmHg-1mm Hg/% (-0.12, 0.59; P=0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each group would provide 90% power to detect statistically significant (P<0.05) between-group difference in a randomised controlled trial.Conclusion: We provide estimates of sample size for a randomised control trial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.Trial registration: ClinicalTrials.gov NCT03598855

AB - Background: Remote ischaemic preconditioning (rIPC) may improve cardiac/cerebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a bout of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. The aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention.Methods: Twenty-one patients with T2DM were randomly allocated to either 7-day daily upper-arm rIPC (4x5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We examined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusion injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention.Results: For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95%CI: 0.69 to 3.80; P=0.09) and 0.23 %cm s-1 %.mmHg-1mm Hg/% (-0.12, 0.59; P=0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each group would provide 90% power to detect statistically significant (P<0.05) between-group difference in a randomised controlled trial.Conclusion: We provide estimates of sample size for a randomised control trial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.Trial registration: ClinicalTrials.gov NCT03598855

KW - Faculty of Science

KW - Remote ischaemic preconditioning

KW - Type 2 diabetes

KW - Vascular function

KW - Ischaemia reperfusion injury

U2 - 10.1530/EJE-19-0378

DO - 10.1530/EJE-19-0378

M3 - Journal article

C2 - 31614332

VL - 181

SP - 659

EP - 669

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 0804-4643

IS - 6

ER -