Islet microangiopathy and augmented β‐cell loss in Japanese non‐obese type 2 diabetes patients who died of acute myocardial infarction

AIMS/INTRODUCTION: Islets have microvessels that might develop pathological alterations similar to microangiopathy in type 2 diabetes patients. It remains unclear, however, whether the changes correlate with endocrine cell deficits or whether the presence of macroangiopathy influences the islet microvasculature in Japanese type 2 diabetes patients. In this study, we characterized changes of the islet microvessels and endocrine cells in Japanese non‐obese patients with type 2 diabetes who died of acute myocardial infarction (AMI). MATERIALS AND METHODS: Clinical profiles and islet pathology were examined for 35 diabetes patients who died of AMI (DM + AMI) and 13 diabetes patients who were free from AMI (DM). A total of 13 age‐matched, individuals without diabetes who died of AMI and 16 individuals without diabetes who were free from AMI were also studied. Pancreata were subjected to morphometric evaluation of islets, including microvascular alterations of immunostained sections. RESULTS: Body mass index in DM + AMI was comparable to those in DM. Compared with DM, DM + AMI showed greater glycated hemoglobin levels, higher prevalence of renal failure, hypertension, smaller β‐cell volume density and greater amyloid area. DM + AMI showed an increased microvascular area and density compared with other groups. There was a significant increase in vascular basement membrane thickness and loss of pericytes in DM and DM + AMI compared with individuals without diabetes in each group, and the extent of thickening was correlated with the amyloid area and occurrence of β‐cell loss in DM + AMI. CONCLUSIONS: Islet microangiopathy was associated with augmented β‐cell loss and amyloid deposition in non‐obese Japanese type 2 diabetes patients who died of AMI.