Cardiovascular disease is the major cause of death in patients with type 1 diabetes. Vascular endothelial dysfunction
is an early pathophysiological precursor of cardiovascular disease. There is extensive evidence that hyperglycemia
causes acute perturbations in endothelial function likely due to increases in oxidative damage. Interestingly, oscillating
hyperglycemia may cause more damage than persistent hyperglycemia. Many, but not all, studies indicate that vascular
endothelial dysfunction occurs early in the course of type 1 diabetes and is present even in adolescents. Ascorbic acid
has been shown to diminish the acute effects of hyperglycemia on endothelial function in type 1 diabetes and in conjunction
with euglycemia to restore endothelial function to normal values in adults with well-controlled diabetes. In vitro and
in vivo animal evidence suggests potential benefit from two other small molecule antioxidants, nicotinamide and taurine.
Early studies suggested that folate supplementation may improve endothelial function in adolescents with type 1 diabetes
but this has not been confirmed by more recent studies. Epidemiological evidence suggests a possible role for vitamin D
therapy although intervention studies in type 2 diabetes have yielded varying results and have not been done in type 1 diabetes.
Further exploration of these and other compounds is clearly appropriate if we are to reduce cardiovascular risk in
type 1 diabetes.
Keywords: Endothelial function, type 1 diabetes, ascorbic acid, nicotinamide, taurine, vitamin D, folic acid.
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