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Seven day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study

Maxwell, JD, Carter, HH, Hellsten, Y, Miller, GD, Sprung, VS, Cuthbertson, DJ, Thijssen, DHJ and Jones, H (2019) Seven day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study. European Journal of Endocrinology, 181 (6). pp. 659-669. ISSN 0804-4643

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Remote ischaemic preconditioning (rIPC) may improve cardiac/cerebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a bout of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. The aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention. Methods: Twenty-one patients with T2DM were randomly allocated to either 7-day daily upper-arm rIPC (4x5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We examined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusion injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention. Results: For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95%CI: 0.69 to 3.80; P=0.09) and 0.23 %cm s-1 %.mmHg-1mm Hg/% (-0.12, 0.59; P=0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each group would provide 90% power to detect statistically significant (P<0.05) between-group difference in a randomised controlled trial. Conclusion: We provide estimates of sample size for a randomised control trial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.

Item Type: Article
Additional Information: The definitive version is now freely available at https://dx.doi.org/10.1530/EJE-19-0378 2019
Uncontrolled Keywords: 1103 Clinical Sciences, 1114 Paediatrics and Reproductive Medicine
Subjects: Q Science > QM Human anatomy
R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Sport & Exercise Sciences
Publisher: BioScientifica
Date Deposited: 14 Nov 2019 11:52
Last Modified: 04 Jan 2022 16:15
DOI or ID number: 10.1530/EJE-19-0378
URI: https://researchonline.ljmu.ac.uk/id/eprint/11620
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