Acute hyperglycemia reduces cerebrovascular reactivity: The role of glycemic variability

Context: Cerebral vasomotor reactivity (CVR) is reduced in patients with diabetes mellitus (DM), and glucose variability (GV) might be responsible for cerebrovascular damage. Objective: Studying patients with insulin resistance without DM, we explored the role of GV in impairing CVR. Patients: We studied 18 metabolic syndrome (MS) patients without DM, 9 controls (C), and 26 patients with DM. Main Outcome Measures: Groups were compared in terms of CVR, GV, and 24-hour blood pressure. To evaluate the impact of acute hyperglycemia on CVR, a hyperglycemic clamp was performed in MS patients and controls. Results: Baseline CVR was reduced inDMvs C and MS (C vsDM=20.2, 95% CI=3.5-36.9, P=.014; and MS vs DM = 22.2, 95% CI = 8.6 -35.8, P = .001), but similar between MS and C (MS vs C = 2.0, 95% CI = -14.7 to 18.7, P = .643). During acute hyperglycemia, CVR fell in MS and C to values comparable to DM. GV progressively increased from C toMS to DM. In MS, CVR at 120 minutes and GV displayed a negative correlation (r=-0.48, P = .043), which did not change after controlling for mean 24-hour systolic and diastolic blood pressure. In MS, the CVR reduction was significantly correlated to GV (r = 0.55, P = .02). Conclusions: GV is increased in patients with MS but withoutDMand is the major predictor of CVR reduction induced by acute hyperglycemia, possibly representing the earliest cause of cerebrovascular damage in DM. Copyright © 2014 by the Endocrine Society.