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Telmisartan shows an equivalent effect of vitamin C in further improving endothelial dysfunction after glycemia normalization in type 1 diabetes

¹Centre of Exellence in Diabetes and Endocrinology, University Hospital of Coventry and Warwickshire, Warwick Medical School, University of Warwick, Coventry, U.K.
²Morpurgo-Hofman Research Laboratory on Aging, Udine, Italy
³Division of Metabolic Diseases, Center of Excellence for Cardiovascular Diseases, University of Naples SUN, Italy.

antonio.ceriello{at}warwick.ac.uk

ABSTRACT

Background:Long-lasting hyperglycemia in type 1 diabetic patients induces permanent alterations of endothelial function, by increased oxidative stress, even when glycemia is normalized.

Methods and Results:In this study 36 type 1 diabetic patients and 12 controls were enrolled. The diabetic patients were divided in three groups. The first group was treated for 24h with insulin, achieving a near-normalization of glycemia. At the 12 h of this treatment vitamin C was added for the remaining 12h. The second group was treated for 24h with vitamin C. At the 12 h of this treatment insulin was started, achieving a near-normalization of glycemia for the remaining 12h. The third group was treated for 24h with both vitamin C and insulin, achieving near normalization of glycemia. The same protocols were run after 1 month of Telmisartan or placebo. Neither normalization of glycemia or vitamin C treatment alone was able to normalize endothelial dysfunction or oxidative stress. Combining insulin and vitamin C normalized endothelial dysfunction and decreased oxidative stress to normal level. Telmisartan significantly improved basal endothelial function and decreased nitrotyrosine plasma levels. In patients treated with Telmisartan a near normalization of both flow mediated vasodilation and oxidative stress was achieved when glycemia was normalized, while adding vitamin C infusion did not show further effect on endothelial function or nitrotyrosine plasma levels.

Conclusions:These data indicate that combining the normalization of glycemia with an antioxidant can normalize endothelial function in type 1 diabetic patients and that Telmisartan works as antioxidant as vitamin C.

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