Plaque Composition in T2DM With and Without Microvascular Complications

Subjects with T2DM who performed CT coronary imaging, as per clinical routine practice.

They will be, therefore, divided into two groups:

• Group A: subjects with T2DM with at least one DMC, as defined:

  • Retinopathy, defined as any diabetes related eye disease (macular oedema, severe non proliferative diabetic retinopathy, proliferative diabetic retinopathy) or previous history of retinal photocoagulation therapy and/or intravitreal injections of anti- vascular endothelial growth factor (VEGF) agents.
  • Neuropathy, including any diabetes-related neurological complication (diabetic peripheral neuropathy, diabetic autonomic neuropathy).
  • Nephropathy, defined as the presence of albuminuria (urinary albumin > 30 mg/g creatinine) and/or an estimated glomerular filtration rate \< 60 mL/min/1.73 m2
• Group B: subjects with T2DM without DMCs.

Following data will be collected Anthropometric parameters

• Sex
• Year of birth
• Height, expressed in m
• Weight, expressed in Kg
• BMI, calculated as weight divided by height squared

Vital signs

• Blood pressure, expressed in mmHg;
• Heart rate, expressed in bpm;
• VFA (Visceral fat area - cm2);
• SFA (subcutaneous fat area - cm2).

Medical history

• Date of diagnosis of diabetes, at least the year;
• Comorbidities;
• Year of diagnosis of comorbidities.
• Smoking habits, defined as "current smoker", "former smoker", "never smoked"

Medications

• Diabetes medications;
• Dose of each diabetes medications;
• Year of start for each diabetes medications;
• Concomitant medications;
• Dose of each concomitant medications;
• Year of start for each concomitant medication.

Cardiovascular risk scores

• SCORE2-Diabetes [12]

Blood Tests data collection

• HbA1c
• Serum Creatinine
• Total Cholesterol
• LDL Cholesterol
• HDL Cholesterol
• Triglycerides
• Transaminases
• Microalbuminuria

Blood sample collection • CRP

Cardiovascular Autonomic Tests

Following Cardiovascular autonomic tests will be performed:

• Deep breathing: The patient sits quietly and breathes deeply at six breaths a minute (five seconds in and five seconds out) for one minute. An electrocardiogram is recorded throughout the period of deep breathing, with a marker used to indicate the onset of each inspiration and expiration.
• Valsalva manoeuvre: The test is performed by the patient blowing into a mouth- piece connected to an aneroid manometer or a modified sphygmomanometer and holding it at a pressure of 40 mm Hg for 15 seconds while a continuous electrocardiogram is recorded. The manoeuvre is performed three times with one- minute intervals between.
• Lying to standing: The test is performed by measuring the patient's blood pressure with a sphygmomanometer while he is lying down quietly and again when he stands up. The postural fall in blood pressure is taken as the difference between the systolic blood pressure lying and the systolic blood pressure standing [13].

Neuropathy evaluation

• Michigan Neuropathy Screening Instrument (MNSI-Q) questionnaire [14]
• COMPASS31 questionnaire [15]
• Diabetic Neuropathy Index (DNI) questionnaire [16]
• DN4 questionnaire [17]
• Monofilament examination

Ophthalmologic evaluation

• Non mydriatic Ocular fundus photography

Coronary CTA parameters collection

• Total EAT
• EAT of atrio_ventricular sulcus
• EAT of anterior interventricular artery, both as volume and thickness
• EAT of right coronary artery
• EAT of circumfl ex coronary artery
• EAT Volume Index (cm3/m2)
• Perivascular FAI (-30 -190 UH)
• CACS (Agatston score, Volume and mass)
• Plaque grading/stenosis (Minimum, mild, intermediate, Severe), using CAD-RADS 2.0
• Plaque characteristics non-calcific, mixed and calcific plaque, evaluating any high-risk plaque profile