Children of diabetics show signs of atherosclerosis

June 20, 2006

(BETHESDA, MD) - The blood vessels of people whose parents both have type 2 diabetes do not respond as well to changes in blood flow as those of people without a family history of diabetes, even if they do not have diabetes themselves, according to a new study in the June 20, 2006, issue of the Journal of the American College of Cardiology.

"We find that offspring of type 2 diabetic parents have endothelial dysfunction, even when they do not have diabetes. If early treatment can prevent progression of atherosclerosis, then identifying groups of persons at risk for diabetes in whom early atherosclerosis may be present is clinically important," said Allison B. Goldfine, M.D. from the Joslin Diabetes Center and Brigham and Women's Hospital in Boston, Massachusetts.

None of the 38 adults (mid- to late-30s) in this study had diabetes, but half of them were the offspring of two diabetic parents. The researchers restricted blood flow in the arms of the participants using a blood pressure cuff. Then, using ultrasound, they compared how blood vessels in the arms of participants responded to the surge in blood flow when the cuff was released. Blood vessel responsiveness was impaired in all 19 participants (9 men and 10 women) whose parents had diabetes.

Diabetes is a leading cause of heart disease. Other studies have linked higher blood sugar levels to impaired responsiveness of the lining of blood vessels (endothelial dysfunction); but this is the first study to demonstrate that even when blood sugar is below the diabetic range, modest increases in blood sugar can contribute to endothelial dysfunction. Endothelial dysfunction in this population shows a predisposition to atherosclerosis.

Type 2 diabetes, also known as adult-onset diabetes, is linked to overweight and obesity. However, obesity and other common risk factors, including age, gender, ethnicity, cholesterol, blood pressure and insulin resistance did not explain the differences observed between participants who had a family history of diabetes and those who did not.

"Persons whose parents both have type 2 diabetes have endothelial dysfunction. This predisposition to atherosclerosis is present even when the offspring do not have diabetes themselves. Insulin resistance has been suggested to be important to both the development of diabetes and cardiovascular disease in large populations. However, in this high-risk group, even the most insulin sensitive offspring had diminished endothelial function," Dr. Goldfine said.

The problem seems to be related to the availability of nitric oxide, a key signaling chemical that triggers blood vessel dilation. The researchers reported that there was no difference between the two groups of participants in how much their blood vessels dilated after treatment with nitroglycerin, which boosts nitric oxide levels in the blood.

While physicians already are told to aggressively combat heart disease risk factors in patients with diabetes, the results of this study suggest even apparently healthy people may have blood vessel problems, if they have a strong family history of diabetes. The researchers did not perform genetic analyses of the participants. In this case, family history includes both genetic inheritance and environmental factors.

"Persons with a strong family history of diabetes are at increased risk of atherosclerosis in addition to risk of diabetes. They may benefit from aggressive cardiovascular risk factor modification, including blood pressure and lipid control, weight management and smoking cessation to reduce their risk of heart attack and stroke," Dr. Goldfine said. "Blood sugar levels, even in the non-diabetic range contribute importantly to endothelial dysfunction and thus the atherosclerotic process. This raises the question of when doctors should recommend interventions to lower glucose levels and what should be the appropriate level of glucose recommended to patients with diabetes."

Dr. Goldfine noted that this study included only a small number of participants. However, she said it did a better job than earlier studies of matching the offspring of diabetics to control subjects; so that the effects of family history could be distinguished from the effects of risk factors such as insulin resistance, obesity, cholesterol and blood pressure.

Ann Marie Schmidt, M.D. from Columbia University Medical Center in New York, NY, who was not connected with this study, said the study was "quite informative," particularly the finding that the participants with a family history of diabetes showed signs of impaired endothelial function in their blood vessels even when they were not only free of diabetes itself, but even when they lacked any insulin resistance, which is one key early sign of a type of diabetes.

"These studies point out that genetic, and perhaps environmental, influences, as the groups were all first-degree relatives, critically impact on endothelial function. Although it is tempting to strictly predict genetic differences underlie this finding, the influence of dietary habits, exercise patterns and perhaps environmental exposures cannot be discounted," Dr. Schmidt said. "Taken together, this fascinating study suggests that irrespective of family history, efforts to limit factors leading to insulin resistance may have frank benefits in enhancing endothelial health and integrity."

Dr. Schmidt noted that the study had only a small number of participants. She also pointed out that the participants with a family history of diabetes had higher fasting glucose levels than the participants without a family history of diabetes.
Disclosure Box
This research was supported by grants from the National Institutes of Health. Dr. Creager is the Simon C. Fireman Scholar in Cardiovascular Medicine at Brigham and Women's Hospital.

American College of Cardiology

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to