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Blood Viscosity in Subjects with Normoglycemia

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Blood Viscosity in Subjects with Normoglycemia 488 Diabetes Care Volume 37, February 2014 Concetta Irace, Claudio Carallo, Blood Viscosity in Subjects With Faustina Scavelli, Maria Serena De Franceschi, Teresa Esposito, and Normoglycemia and Prediabetes Agostino Gnasso OBJECTIVE Blood viscosity (BV) is higher in diabetic patients and might represent a risk factor for the development of insulin resistance and type 2 diabetes. However, data in subjects with normal glucose or prediabetes are missing. In the current study, we evaluated the relationship between BV and blood glucose in subjects with normal glucose or prediabetes. RESEARCH DESIGN AND METHODS Enrolled subjects were divided into three groups according to blood glucose: group A (n = 74), blood glucose <90 mg/dL; group B (n = 96), blood glucose ranging from 90 to 99 mg/dL; and group C (n = 94), blood glucose ranging from 100 to 125 mg/dL. BV was measured at 378C with a cone-plate viscometer at shear rates ranging from 225 to 22.5 s21. RESULTS Blood pressure, blood lipids, fibrinogen, and plasma viscosity were similar in the three groups. BMI and waist circumference were significantly increased in group C. Hematocrit (P < 0.05) and BV (P between 0.01 and 0.001) were significantly higher in groups B and C compared with group A. Blood glucose was significantly and PATHOPHYSIOLOGY/COMPLICATIONS inversely correlated with HDL cholesterol and directly with BMI, waist, hematocrit (r = 0.134), and BV (from 225 s21 to 22.5 s21; r ranging from 0.162 to 0.131). BV at shear rate 225 s21 was independently associated with blood glucose. CONCLUSIONS The current study shows a direct relationship between BV and blood glucose in nondiabetic subjects. It also suggests that, even within glucose values considered completely normal, individuals with higher blood glucose levels have increased BV Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore,”“Magna Græcia” University, comparable with that observed in subjects with prediabetes. Catanzaro, Italy – Diabetes Care 2014;37:488 492 | DOI: 10.2337/dc13-1374 Corresponding author: Agostino Gnasso, [email protected]. Received 10 June 2013 and accepted 13 Blood viscosity (BV) is the force that counteracts the free sliding of the blood layers September 2013. within the circulation and depends on the internal cohesion between the molecules C.I. and C.C. contributed equally to this article. and the cells. Abnormally high BV can have several negative effects: the heart is © 2014 by the American Diabetes Association. overloaded to pump blood in the vascular bed, and the blood itself, more viscous, See http://creativecommons.org/licenses/by- can damage the vessel wall. Furthermore, according to Poiseuille’s law (1), BV is nc-nd/3.0/ for details. care.diabetesjournals.org Irace and Associates 489 inversely related to flow and might According to blood glucose levels, 22.5 s21. For plasma viscosity, the therefore reduce the delivery of insulin participants were divided into three average of measurements at shear rates and glucose to peripheral tissues, groups: group A, blood glucose ,90 mg/dL; of 225 and 90 s21 was calculated. The leading to insulin resistance or diabetes group B, blood glucose between coefficient of variation for blood and (2–5). 90 and 99 mg/dL; and group C, blood plasma viscosity was ,3%. It is generally accepted that BV is glucose between 100 and 125 mg/dL. Microhematocrit was measured increased in diabetic patients (6–8). The ethics committee of Azienda without correction for plasma trapping. fi Although the reasons for this alteration Policlinico Mater Domini approved the The coef cient of variation for ; are still under investigation, it is study. All recruited subjects gave microhematocrit was 1%. believed that the increase in osmolarity informed consent. Erythrocyte rigidity (Tk) was evaluated causes increased capillary permeability All subjects included in the study according to the Dintenfass formula: m 0.4 2 · m 0.4 · 21 and, consequently, increased hematocrit underwent a complete clinical Tk = ( r 1) ( r h) ,where m and viscosity (9). It has also been examination and blood withdrawal. h is hematocrit and r is the relative suggested that the osmotic diuresis, Standing height without shoes was BV (BV/plasma viscosity). consequence of hyperglycemia, could measured to the nearest 0.5 cm. Weight Statistical Analysis contribute to reduce plasma volume was measured to the nearest 0.1 kg in and increase hematocrit (10). All statistical analyses were performed ordinary street clothes. BMI was by SPSS 17.0 for Windows. All studied Cross-sectional studies have also computed as weight (in kg) divided by variables except triglycerides had 2 supported a link between BV, hematocrit, height (in m ). Waist circumference was normal distribution. Triglycerides were – and insulin resistance (11 17). Recently, measured midway between the lower log transformed before analyses. One- a large prospective study has rib margin and the iliac crest. Systolic way ANOVA and LSD post hoc test were demonstrated that BV and hematocrit and diastolic blood pressure was used to test the difference in studied are risk factors for type 2 diabetes. measured, on the right arm, after the variables between groups with different Subjects in the highest quartile of BV participant had been resting for at blood glucose concentrations. Pearson . were 60% more likely to develop least 5 min, with a standardized correlation coefficient was used to test diabetes than their counterparts in the sphygmomanometer. Cigarette the correlation between continuous fi fi lowest quartile (18). This nding con rms smoking and ongoing drug therapies variables. Multiple linear regression previous observations obtained in smaller were investigated by questionnaire. analysis was performed to evaluate the or selected populations, in which the Venous blood for routine and viscosity independent association of clinical and association between hemoglobin or analyses was collected in the morning biochemical variables with blood hematocrit and occurrence of type 2 before the breakfast after overnight glucose. diabetes was investigated (19–22). fasting in order to avoid the influence of These observations suggest that the postprandial lipid increase on RESULTS elevation in BV may be very early, well hemorheological parameters (25). The clinical, biochemical, and before the onset of diabetes, but hemorheological characteristics of the Attention was paid to avoid venous definite data in subjects with normal 264 participants are shown in Table 1. stasis, and the hemostatic loop, when glucose or prediabetes are missing. In Seventy-four subjects had blood glucose used, was immediately removed after the current study, we evaluated the ,90 mg/dL (group A), 96 subjects had cannulation of the vein. Blood glucose relationship between BV and blood blood glucose ranging from 90 to 99 and lipids were measured by routine glucose in subjects with normal glucose mg/dL (group B), and 94 had blood methods. Subjects with blood glucose or prediabetes in order to verify whether glucose ranging from 100 to 125 mg/dL ,100 mg/dL were classified as alterations in viscosity are appreciable (group C). Blood pressure, blood lipids, nondiabetic, those with values between in these subjects and at which blood fibrinogen, and plasma viscosity were 100 and 125 mg/dL were classified as glucose concentration they appear. similar in the three groups. BMI and prediabetic, and those with blood waist were significantly increased in . fi RESEARCH DESIGN AND METHODS glucose 125 mg/dL were classi ed as subjects with prediabetes (group C) Subjects were enrolled among free- diabetic and excluded from the present compared with the other two groups living participants in a cardiovascular analysis. (P , 0.05). Subjects with high normal disease prevention program between Blood and plasma viscosity were blood glucose were younger (P , 0.05) February 2011 and December 2012 measured within 2 h from blood compared with the other two groups. (23,24). In order to reduce the influence withdrawal; the blood specimen was Hematocrit (P , 0.05) and BV of confounding factors, cigarette added with heparin (35 IU/mL). (P between 0.01 and 0.001) were smoking, diabetes, plasma triglycerides Viscosity measurement was performed significantly higher in subjects with .400 mg/dL, female sex before at 378C with a cone-plate viscometer prediabetes and in those with blood menopause, and drug use (chronic (Wells-Brookfield DV-III; Wells- glucose ranging from 90 to 99 mg/dL treatment and any drug in the week Brookfield, Stoughton, MA) equipped compared with subjects with blood before blood withdrawal) were exclusion with a cp-40 spindle. BV was recorded glucose ,90 mg/dL. Tk was similar in criteria for the present analysis. at shear rates ranging from 225 to the three groups. 490 Blood Viscosity and Blood Glucose Diabetes Care Volume 37, February 2014 Table 1—Clinical, biochemical, and rheological characteristics of subjects [0.355], and Tk [0.377]). The results Group A Group B Group C P indicate that hematocrit, plasma viscosity, and erythrocyte deformability n 74 96 94 are the only variables independently 6 6 6 # Age (years) 56.2 12.4 52.8 10.8 57.2 10.0 0.02 associated with the viscosity in these Cholesterol (mg/dL) 209 6 41 220 6 40 213 6 40 #0.23 subjects. Triglycerides (mg/dL) 116 6 51 132 6 64 141 6 74 #0.09 HDL cholesterol (mg/dL) 53 6 17 51 6 15 49 6 12 #0.27 CONCLUSIONS Glucose (mg/dL) 85 6 5956 3 108 6 7 d BMI (kg/m2)28.36 4.1 28.0 6 4.5 29.9 6 4.9 #0.01 The current study shows, for the first Waist (cm) 91 6 10 91 6 13 96 6 10 #0.01 time, a direct relationship between BV SBP (mmHg) 139 6 22 136 6 19 139 6 24 #0.60 and blood glucose in nondiabetic DBP (mmHg) 86 6 10 85 6 10 87 6 10 #0.59 subjects.
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