Effects of analogue insulin in multiple daily injection therapy of type 2 diabetes on postprandial glucose control and cardiac function compared to human insulin: a randomized controlled long-term study

Autor: Markus Riemer, Petra-Maria Schumm-Draeger, Iris Kingreen, T. Siegmund, Tibor Schuster, Helene von Bibra
Rok vydání: 2016
Předmět:
Blood Glucose
Male
Time Factors
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Type 2 diabetes
030204 cardiovascular system & hematology
Ventricular Function
Left
Analogue insulins
0302 clinical medicine
Insulin Detemir
Diastole
Germany
Medicine
Prospective Studies
Original Investigation
Insulin detemir
Aged
80 and over
Middle Aged
Postprandial Period
Treatment Outcome
Postprandial
Cardiology
Diastolic dysfunction
Female
Cardiology and Cardiovascular Medicine
Diastolic cardiac function
medicine.drug
Adult
Cardiac function curve
medicine.medical_specialty
030209 endocrinology & metabolism
Drug Administration Schedule
Metabolic control
Injections
Insulin aspart
03 medical and health sciences
Insulin resistance
Diabetes mellitus
Internal medicine
Human insulin
Humans
Hypoglycemic Agents
Insulin Aspart
Aged
Echocardiography
Doppler
Pulsed
Glycated Hemoglobin
business.industry
Insulin
medicine.disease
Postprandial glucose
Endocrinology
Diabetes Mellitus
Type 2
business
Biomarkers
Zdroj: Cardiovascular Diabetology
ISSN: 1475-2840
DOI: 10.1186/s12933-015-0320-2
Popis: Background The prevention of cardiovascular disease, including diastolic cardiac dysfunction with its high prevalence and ominous prognosis, is a therapeutic challenge for patients with type 2 diabetes. Both short and long-acting insulin analogues (AI) have been shown to reduce glucose variability and provide potential benefit for cardiovascular disease although the effects on cardiac function have not yet been evaluated. This long-term, prospective, randomized controlled trial in patients with type 2 diabetes (T2D) tested the hypothesis that a multiple daily injection regimen (MDI) with AI improves postmeal glucose excursions in comparison to human insulin (HI) and that the effects of AI improve diastolic cardiac function. Methods For 36 months, MDI treatment in 109 T2D patients was adapted every 3 months (targets: fasting glucose ≤ 110 mg/dl, postmeal glucose ≤ 150 mg/dl) in both groups: AI (insulin detemir and insulin aspart, n = 61) and HI (NPH-insulin and regular HI, n = 48). Diastolic cardiac function (myocardial velocity E’ using tissue Doppler imaging and the mitral inflow ratio E/A) and vascular function were assessed before and 2 h after a standardized breakfast (48 g carbohydrates). At baseline, both groups were comparable with regards to demographic, cardiac and metabolic data. Analysis of data included traditional statistics as well as the use of a multiple imputation technique shown in brackets [ ]. Results At 36 months, the primary endpoint, postmeal glucose, decreased by 20 ± 62 mg/dl, p = 0.038 [p = 0.021] with AI and increased insignificantly with HI (inter-group p = 0.032 [p = 0.047]) to postmeal glucose levels of 161 ± 39 with AI vs. 195 ± 54 mg/dl with HI (inter-group p = 0.002 [p = 0.010]) whereas the levels of fasting glucose and HbA1c were comparable. With AI, postmeal E’ improved by 0.6 ± 1.4 cm/s, p = 0.009 [p = 0.002] and fasting E’ by 0.4 ± 1.4 cm/s, p = 0.069 [p = 0.013], however, E’ remained unchanged with HI. These changes were consistent with those of the traditional parameter E/A. Conclusions MDI with AI results in better postmeal glucose control compared to HI. The treatment with AI is associated with improved diastolic cardiac function. ClinicalTrials.gov (NTC00747409)
Databáze: OpenAIRE
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