A randomized trial of the impact of strict glycaemic control on myocardial diastolic function and perfusion reserve: a report from the DADD (Diabetes mellitus And Diastolic Dysfunction) study
| Autor: | Lena Landstedt-Hallin, John Öhrvik, Hans Persson, Anders Melcher, Christina Jarnert, Lars Rydén, Klas Malmberg |
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| Rok vydání: | 2009 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty medicine.medical_treatment Diastole Type 2 diabetes law.invention Ventricular Dysfunction Left Randomized controlled trial law Coronary Circulation Internal medicine Diabetes mellitus Humans Medicine Aged business.industry Insulin Coronary flow reserve Middle Aged medicine.disease Echocardiography Doppler Diabetes Mellitus Type 2 Hyperglycemia Metabolic control analysis Heart failure Cardiology Female Cardiology and Cardiovascular Medicine business Diabetic Angiopathies |
| Zdroj: | European Journal of Heart Failure. 11:39-47 |
| ISSN: | 1388-9842 |
| DOI: | 10.1093/eurjhf/hfn018 |
| Popis: | Aims Myocardial diastolic dysfunction (MDD) and impaired coronary flow reserve (CFR) are early signs of myocardial involvement in patients with diabetes. The important question of whether this may be reversed by glucose normalization has not been tested in a controlled clinical trial. We hypothesized that strict glycaemic control, particularly if insulin based, will improve MDD and CFR. Methods and results Thirty-nine type 2 diabetes patients (mean age 61.0 ± 7 years) with signs of diastolic dysfunction were randomly assigned to strict metabolic control by insulin (I-group; n = 21) or oral glucose lowering agents (O-group; n = 18). MDD and CFR were studied with Doppler-echocardiography including Tissue Doppler Imaging and myocardial contrast enhanced echocardiography. Fasting glucose (I-group = −2.2 ± 2.1; O-group −1.5 ± 0.8 mmol/L) and HbA1c were normalized (−0.6 ± 0.4 and −0.7 ± 0.4%, respectively) in both groups, but this did not significantly improve MDD in either of the groups (P = 0.65). There was no difference in CFR before and after improved glycaemic control. Conclusion The hypothesis that strict glycaemic control would reverse early signs of MDD and improve CFR in patients with type 2 diabetes could not be confirmed, despite achieved normalization. Whether it is possible to influence a more pronounced diastolic dysfunction, particularly in less well-controlled diabetic patients, remains to be established. |
| Databáze: | OpenAIRE |
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