Decreased vascular endothelial growth factor response to acute hypoglycemia in type 2 diabetic patients with hypoglycemic coma

• Published in: Cytokine (Philadelphia, Pa.) Vol. 57; no. 3; pp. 372 - 378
• Main Authors: Arnalich, Francisco, Maldifassi, Maria Constanza, Atienza, Gema, Ciria, Enrique, Quesada, Angustias, Cedillo, José Luis, Renart, Jaime, Codoceo, Rosa, Herruzo, Rafael, Montiel, Carmen
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2012
• Subjects: Aged; brain; Cohort Studies; coma; Coma - blood; Coma - complications; consciousness; cortisol; cytokines; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; epinephrine; Female; Humans; hypoglycemia; Hypoglycemia - blood; Hypoglycemia - complications; Hypoglycemia unawareness; Hypoglycemic coma; Logistic Models; Male; Multivariate Analysis; noninsulin-dependent diabetes mellitus; norepinephrine; patients; Plasma concentrations; regression analysis; somatotropin; Type 2 diabetic patients; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - blood; vascular endothelial growth factors; Plasma concentrations; Type 2 diabetic patients; Hypoglycemia unawareness; Vascular endothelial growth factor; Hypoglycemic coma
• ISSN: 1043-4666; 1096-0023
• DOI: 10.1016/j.cyto.2011.12.003

Plasma vascular endothelial growth factor (VEGF) was shown to increase during acute hypoglycemia and could mediate rapid adaptation of the brain. In this study we examined the neuroendocrine response in patients with type 2 diabetes mellitus (T2DM) in hypoglycemic coma or with acute neuroglycopenic symptoms.
We prospectively studied 135 consecutive T2DM patients admitted for severe hypoglycemia during a 2-year period. We collected clinical variables and measured plasma concentrations of VEGF, epinephrine, norepinephrine, cortisol and growth hormone at admission and 30min afterwards.
Thirty two patients developed hypoglycemic coma and 103 did not lose consciousness. Median plasma VEGF level of coma patients was 3.1-fold lower at baseline than that of non-coma patients, and even 5.3-fold lower 30min afterwards. Plasma epinephrine concentration was significantly lower just at baseline in coma patients. On the contrary, there were no differences in concentrations of the other hormones. Multivariate logistic regression analysis showed that VEGF concentration (OR 0.68; CI 0.51–0.95) was a protective factor against the development of coma.
VEGF and epinephrine responses to acute hypoglycemia are reduced in T2DM patients who develop hypoglycemic coma. An increased plasma VEGF concentration appeared to be a protective factor against the development of hypoglycemic coma.