Diabetes Mellitus, Type 2 Clinical Trial
Official title:
Skin and Retina Microvascular Endothelial Function in Healthy, Insulin Resistant and Type 2 Diabetic Subjects
The purpose of this study is to investigate microvascular endothelial function in the retina of lean, obese, and type 2 diabetic subjects and to compare microvascular endothelial function in the retina with several other established markers of endothelial and microvascular function.
Insulin resistance is an early feature in obese patients lasting from hyperinsulinaemia with
normal glycaemic control to impaired glucose tolerance and clinically manifest type 2
diabetes. Insulin resistance is closely associated to endothelial dysfunction and many other
cardiovascular risk markers summarised under the definition of the metabolic syndrome.
During the recent years, insulin resistance and the development of endothelial dysfunction
were recognized as important pathogenetic drivers in the development of atherosclerosis and
major predictors in the development of micro and macrovascular complications like
retinopathy, nephropathy, myocardial infarction or stroke.
Several different technologies have been developed for the measurement of endothelial
function in distinct vascular compartments like the flow mediated vasodilatation in the
brachial artery, or numerous laser Doppler based technologies for the measurement of
endothelial dependent microvascular blood flow responses in the skin. Even retinal vascular
morphology could be easily visualized by direct fundoscopy, the investigation of retinal
endothelial function had been a diagnostical challenge for decades. During the recent years,
laser doppler scanning of the retina has become a widely used technology for the measurement
of microvascular blood flow in the retina. Recently a new stimulation technology for the
investigation of endothelial function in the retina has been developed and validated.
Application of flickering light to the retina increases retinal blood flow by the
stimulation of endothelial nitric oxide (NO) release, and laser Doppler scanning of the
retina before and after the flicker light application could be used for the investigation of
microvascular endothelial function in the eye. For assessing the stage of retinopathy a
retinal image of 45° (papilla-centered) will be performed using a digital non-mydriatic
fundus camera (Kowa Nonmyd 5). The image will be evaluated in respect to diabetic and
hypertensive retinopathy in a standardized method. Also the equivalent arteriolar and venous
diameter of the retinal vessels will be measured and the arterio-venous ratio will be
calculated.
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Observational Model: Case Control, Time Perspective: Prospective
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