TY - JOUR
T1 - Endothelial function in patients with newly diagnosed type 2 diabetes receiving early intensive insulin therapy
AU - Tian, Jing
AU - Wang, Jingfeng
AU - Li, Yan
AU - Villarreal, Daniel
AU - Carhart, Robert
AU - Dong, Yanbin
AU - Wen, Yanling
AU - Liu, Kan
N1 - Funding Information:
Study design. Both healthy subjects and diabetic patients received FMD and plasma vWF measurement at the beginning of the study. Only diabetic patients participated in subsequent randomized prospective intervention study. Before the intervention began, they were randomly allocated into two groups (according to the table of random numbers): group A and B. In group A, the patients were treated with multifactorial intervention therapy with hypoglycemic, antihypertensive, and lipid-lowering agent. In group B, the patients were treated with early intensive insulin therapy (Table 1 and Figure 1). During follow-up, occurrence of any cardiovascular disease (physician-diagnosed myocardial infarction, angina, heart failure, stroke, or transient ischemic attack or underwent an invasive cardiovascular procedure) meant the termination of this study. The study was sponsored by National Natural Science Foundation of China (No. 30973480) and the Science & Technology Program of Guangdong Province (No. 2009B060700104). No pharmaceutical company had role in the design of the study, the accrual or analysis of the data, or the preparation of the manuscript. All authors vouch for the accuracy and completeness of the data and the analysis. The protocol was approved by the institutional review board at each of the 12 participating centers and the ethics committee of the Sun Yat-sen University. All patients gave written informed consent to the study. An independent data and safety monitoring committee monitored safety and efficacy.
Funding Information:
Acknowledgments:This study was funded by National Natural Science Foundation of china (No. 30973480) and the Science &Technology Program of Guangdong Province (No.2009b060700104).There are no relationships with industry. This trial (including all study protocols) was approved by the institutional review board at each of the 12 participating centers and the ethics committee of the SunYat-sen University. All patients gave written informed consent to the study. An independent data and safety monitoring committee monitored safety and efficacy.
PY - 2012/12
Y1 - 2012/12
N2 - Background Multifactorial intervention is unable to improve endothelial dysfunction/cardiovascular outcome in type 2 diabetes. Intensive insulin therapy improves pancreatic β-cell dysfunction in patients with early stage diabetes. We investigated the effect of intensive insulin therapy on endothelial dysfunction in these patients.MethodsOne hundred and sixteen patients with newly diagnosed type 2 diabetes and 59 healthy subjects received flow-mediated dilatation (FMD) and von Willebrand factor (vWF) measurement. Diabetic patients were further treated with either multifactorial intervention (group A), or intensive insulin therapy (group B) for 2 weeks. Both FMD and vWF measurement were repeated at the same time. FMD was reassessed 90 days after intervention.ResultsCompared with healthy subjects, FMD in diabetic patients was significantly lower (group A: 15.99 ± 7.81 % vs. 25.17 ± 7.12 %, P < 0.01; group B: 16.85 ± 7.30 % vs. 25.17 ± 7.12%, P < 0.01), plasma vWF was significantly higher (group A: 224.34 ± 7.36 U/l vs. 109.69 ± 6.30 U/l, P < 0.01; group B: 219.18 ± 6.92 U/l vs. 109.69 ± 6.30 U/l, P < 0.01). After treatment, there was no significant change of FMD in either group. The vWF did not change after multifactorial intervention (220.96 ± 6.85 U/l vs. 224.34 ± 7.36 U/l, P = 0.49), but significantly decreased after intensive insulin therapy (155.08 ± 11.82 U/l vs. 219.18 ± 6.92 U/l, P = 0.0013).ConclusionsIntensive insulin therapy significantly improves endothelial injury/dysfunction as measured by vWF in early stage type 2 diabetes. Further study is needed to determine whether plasma vWF can help early identification, stratification and management of diabetic endothelial dysfunction.
AB - Background Multifactorial intervention is unable to improve endothelial dysfunction/cardiovascular outcome in type 2 diabetes. Intensive insulin therapy improves pancreatic β-cell dysfunction in patients with early stage diabetes. We investigated the effect of intensive insulin therapy on endothelial dysfunction in these patients.MethodsOne hundred and sixteen patients with newly diagnosed type 2 diabetes and 59 healthy subjects received flow-mediated dilatation (FMD) and von Willebrand factor (vWF) measurement. Diabetic patients were further treated with either multifactorial intervention (group A), or intensive insulin therapy (group B) for 2 weeks. Both FMD and vWF measurement were repeated at the same time. FMD was reassessed 90 days after intervention.ResultsCompared with healthy subjects, FMD in diabetic patients was significantly lower (group A: 15.99 ± 7.81 % vs. 25.17 ± 7.12 %, P < 0.01; group B: 16.85 ± 7.30 % vs. 25.17 ± 7.12%, P < 0.01), plasma vWF was significantly higher (group A: 224.34 ± 7.36 U/l vs. 109.69 ± 6.30 U/l, P < 0.01; group B: 219.18 ± 6.92 U/l vs. 109.69 ± 6.30 U/l, P < 0.01). After treatment, there was no significant change of FMD in either group. The vWF did not change after multifactorial intervention (220.96 ± 6.85 U/l vs. 224.34 ± 7.36 U/l, P = 0.49), but significantly decreased after intensive insulin therapy (155.08 ± 11.82 U/l vs. 219.18 ± 6.92 U/l, P = 0.0013).ConclusionsIntensive insulin therapy significantly improves endothelial injury/dysfunction as measured by vWF in early stage type 2 diabetes. Further study is needed to determine whether plasma vWF can help early identification, stratification and management of diabetic endothelial dysfunction.
KW - blood pressure
KW - brachial artery flow-mediated dilation
KW - early intensive insulin therapy
KW - hypertension
KW - type 2 diabetes
KW - vascular endothelial dysfunction
KW - von Willebrand factor
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U2 - 10.1038/ajh.2012.122
DO - 10.1038/ajh.2012.122
M3 - Article
C2 - 22895449
AN - SCOPUS:84869205085
SN - 0895-7061
VL - 25
SP - 1242
EP - 1248
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 12
ER -
