α-Glucosidase inhibitor miglitol attenuates glucose fluctuation, heart rate variability and sympathetic activity in patients with type 2 diabetes and acute coronary syndrome: a multicenter randomized controlled (MACS) study
| Autor: | Kozue Ogasawara, Toshiyuki Niki, Osamu Arasaki, Masaharu Ishihara, Hiroki Ikenaga, Kazuoki Dai, Yohei Inoue, Akira Takashima, Masataka Sata, Atsushi Tanaka, Yoshisato Shibata, Michio Shimabukuro, Yutaka Mori, Koichi Oshiro, Shinji Kishimoto, Koichi Node |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Acute coronary syndrome lcsh:Diseases of the circulatory (Cardiovascular) system 1-Deoxynojirimycin Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Hypoglycemia 03 medical and health sciences 0302 clinical medicine Heart Rate Internal medicine Diabetes mellitus Heart rate medicine Humans Hypoglycemic Agents Heart rate variability Glycoside Hydrolase Inhibitors Glucose fluctuation Original Investigation Aged business.industry Miglitol Type 2 Diabetes Mellitus Middle Aged medicine.disease Sympathetic nervous system activity Glucose Treatment Outcome Diabetes Mellitus Type 2 lcsh:RC666-701 Anesthesia Cardiology Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Cardiovascular Diabetology, Vol 16, Iss 1, Pp 1-12 (2017) Cardiovascular Diabetology |
| ISSN: | 1475-2840 |
| DOI: | 10.1186/s12933-017-0571-1 |
| Popis: | Background Little is known about clinical associations between glucose fluctuations including hypoglycemia, heart rate variability (HRV), and the activity of the sympathetic nervous system (SNS) in patients with acute phase of acute coronary syndrome (ACS). This pilot study aimed to evaluate the short-term effects of glucose fluctuations on HRV and SNS activity in type 2 diabetes mellitus (T2DM) patients with recent ACS. We also examined the effect of suppressing glucose fluctuations with miglitol on these variables. Methods This prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group comparative study included 39 T2DM patients with recent ACS, who were randomly assigned to either a miglitol group (n = 19) or a control group (n = 20). After initial 24-h Holter electrocardiogram (ECG) (Day 1), miglitol was commenced and another 24-h Holter ECG (Day 2) was recorded. In addition, continuous glucose monitoring (CGM) was performed throughout the Holter ECG. Results Although frequent episodes of subclinical hypoglycemia (≤4.44 mmo/L) during CGM were observed on Day 1 in the both groups (35% of patients in the control group and 31% in the miglitol group), glucose fluctuations were decreased and the minimum glucose level was increased with substantial reduction in the episodes of subclinical hypoglycemia to 7.7% in the miglitol group on Day 2. Holter ECG showed that the mean and maximum heart rate and mean LF/HF were increased on Day 2 in the control group, and these increases were attenuated by miglitol. When divided 24-h time periods into day-time (0700–1800 h), night-time (1800–0000 h), and bed-time (0000–0700 h), we found increased SNS activity during day-time, increased maximum heart rate during night-time, and glucose fluctuations during bed-time, which were attenuated by miglitol treatment. Conclusions In T2DM patients with recent ACS, glucose fluctuations with subclinical hypoglycemia were associated with alterations of HRV and SNS activity, which were mitigated by miglitol, suggesting that these pathological relationships may be a residual therapeutic target in such patients. Trial registration Unique Trial Number, UMIN000005874 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000006929) |
| Databáze: | OpenAIRE |
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