Effect of normalization of fasting glucose by intensified insulin therapy and influence of eNOS polymorphisms on the incidence of restenosis after peripheral angioplasty in patients with type 2 diabetes: a randomized, open-label clinical trial
| Autor: | Alessandro Del Maschio, Massimo Venturini, Roberto Chiesa, Valentina Villa, Antonio Colombo, Ermal Shehaj, Enrico Maria Marone, Elena Galluccio, Pier Marco Piatti, Pietro Lucotti, Flavio Airoldi, Lucilla D. Monti, Emanuele Bosi, Manuela Mantero, Alessio Palini, Ezio Faglia, Francesca Perticone, Emanuela Setola |
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| Přispěvatelé: | Piatti, Pm, Marone, E, Mantero, M, Setola, E, Galluccio, E, Lucotti, P, Shehaj, E, Villa, V, Perticone, F, Venturini, M, Palini, A, Airoldi, F, Faglia, E, DEL MASCHIO, Alessandro, Colombo, A, Chiesa, Roberto, Bosi, Emanuele, Monti, Ld |
| Rok vydání: | 2012 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Nitric Oxide Synthase Type III Endocrinology Diabetes and Metabolism medicine.medical_treatment Kaplan-Meier Estimate Type 2 diabetes Gastroenterology Peripheral Arterial Disease Endocrinology Restenosis Enos Internal medicine Diabetes mellitus Angioplasty Internal Medicine medicine Humans Hypoglycemic Agents Insulin Progenitor cell Aged Aged 80 and over Polymorphism Genetic biology business.industry Incidence Extremities Fasting General Medicine Critical limb ischemia Middle Aged biology.organism_classification medicine.disease Treatment Outcome Diabetes Mellitus Type 2 Female medicine.symptom business |
| Zdroj: | Acta Diabetologica. 50:373-382 |
| ISSN: | 1432-5233 0940-5429 |
| Popis: | "Primary objective was to evaluate whether an intensified insulin therapy (IIT) incorporating the target of normal fasting glucose and HbA1c levels could halve the incidence of restenosis\/amputation\/SCA\/death at 6 months after peripheral angioplasty compared with standard care (SC) in patients with type 2 diabetes (DMT2) affected by critical limb ischemia (CLI). Forty-six consecutive patients with DMT2 and CLI were randomly assigned to a parallel, open-label study with IIT (basal-bolus glulisine + glargine administrations) or SC (glargine administration + oral antidiabetic drugs). A SNP of eNOS (rs753482-A>C) and circulating CD34(+) and CD34(+)KDR(+) progenitor cells were determined. At the end of the study, although HbA1c levels were lower in IIT than in SC (6.9 ± 1.3 % vs. 7.6 ± 1.2 %, p < 0.05), IIT did not reduce the cumulative incidence of restenosis\/amputation\/SCA\/death (52 and 65 %, respectively, odd ratio 0.59; CI 95 %: 0.21-1.62, p = 0.59). rs753482AC+CC as compared with rs753482AA increased the cumulative incidence of restenosis\/amputation\/SCA\/death (79 and 42 %; odd ratio 5.3; CI 95 %: 1.41-19.5, p < 0.02). Baseline CD34(+)KDR(+) were higher in rs753482AA (166.2 ± 154.0 × 10(6) events) than in rs753482AC+CC (63.1 ± 26.9 × 10(6) events, p < 0.01). At the end of the study, the highest circulating CD34(+)KDR(+) were found in IIT rs753482AA (246.9 ± 194.0 × 10(6) events) while the lowest levels were found in SC rs753482AC+CC (70.9 ± 45.0 × 10(6) events). IIT did not decrease the cumulative incidence of restenosis\/amputation\/SCA\/death in DMT2 and CLI patients. These patients correspond to a class of fragile subjects at high risk of cardiovascular events, and new predictors of restenosis should be contemplated, such as of eNOS polymorphism, (rs753482-A>C SNP) and circulating endothelial progenitor cells" |
| Databáze: | OpenAIRE |
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