dc.contributor.advisor |
Braatvedt, Geoff |
en |
dc.contributor.author |
Bagg, Warwick |
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dc.date.accessioned |
2009-11-19T03:36:50Z |
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dc.date.available |
2009-11-19T03:36:50Z |
en |
dc.date.issued |
2001 |
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dc.identifier |
W4 B144 2001 |
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dc.identifier.citation |
Thesis (MD)--University of Auckland, 2001. |
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dc.identifier.uri |
http://hdl.handle.net/2292/5534 |
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dc.description |
Full text is available to authenticated members of The University of Auckland only. |
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dc.description.abstract |
Background
Many patients with type 2 diabetes experience significant morbidity and mortality as a consequence of concomitant cardiovascular disease. Traditional risk factors for vascular disease do not account for the excess cardiovascular risk seen in patients with diabetes and thus hyperglycaemia per se may account for this excess risk. The aims of this thesis were three fold.
1. To determine the effects of acute hyperglycaemia on endothelial function in healthy individuals.
2. To study the effects of improved glycaemic control on endothelial function and body composition in patients with type 2 diabetes.
3. To determine what factors predict endothelial activation in patients with type 2 diabetes.
Methods
Ultrasound detected changes in brachial artery diameter, in response to forearm ischaemia were used to calculate percentage flow-mediated dilatation (FMD). Brachial artery FMD correlates with coronary artery endothelial function and is therefore a non-invasive marker of coronary artery endothelial function.
The concentrations of soluble adhesion markers were used as markers of endothelial function.
Change in body composition was assessed by Dual energy X-ray absorptiometry.
To determine the effects of acute hyperglycaemia on brachial artery FMD, 10% dextrose or normal saline was infused for one hour in 10 healthy subjects in a cross over study.
To determine the effects of improved glycaemic control on brachial artery FMD and weight change in patients with type 2 diabetes, 43 patients were randomised to improved glycaemic control or usual glycaemic control for a 20 week study period.
Results
Acute mild hyperglycaemia had no effect on brachial artery FMD in healthy subjects.
Patients with type 2 diabetes and poor glycaemic control had endothelial activation and impaired FMD at baseline. Obesity was the only significant predictor of endothelial activation. Despite a significant improvement in glycaemic control, brachial artery FMD and endothelial activation were not altered at the end of the 20 week study period. Improved glycaemic control was associated with modest weight gain but no effects on blood pressure or serum lipid concentrations.
Conclusions
1. Acute mild hyperglycaemia does not adversely affect brachial artery FMD.
2. Short-term improvement in glycaemic control does not improve brachial artery FMD in patients with type 2 diabetes nor does it result in reduced endothelial activation but does result in modest weight gain.
3. Obesity independently of blood pressure or glycaemic control predicts endothelial activation in patients with type 2 diabetes. |
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dc.publisher |
ResearchSpace@Auckland |
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dc.relation.ispartof |
PhD Thesis - University of Auckland |
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dc.relation.isreferencedby |
UoA99105607114002091 |
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dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated |
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dc.rights |
Restricted Item. Available to authenticated members of The University of Auckland. |
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dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
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dc.title |
Effects of improved glycaemic control on endothelial function and body composition in patients with type 2 diabetes mellitus |
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dc.type |
Thesis |
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thesis.degree.discipline |
Medicine |
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thesis.degree.grantor |
The University of Auckland |
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thesis.degree.level |
Doctoral |
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thesis.degree.name |
MD |
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dc.subject.marsden |
Fields of Research::320000 Medical and Health Sciences::320100 Medicine-General |
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dc.rights.holder |
Copyright: the author |
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pubs.local.anzsrc |
110000 Medical and Health Sciences |
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dc.identifier.wikidata |
Q112856466 |
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