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Abstract
Objective Glucose variability induces endothelial dysfunction and cardiac autonomic nerve abnormality. Here we compared the effects of mealtime insulin aspart and bedtime insulin detemir on glucose variability, endothelial function, and cardiac autonomic nerve activity among Japanese patients with type 2 diabetes.
Research design and methods Forty hospitalized patients received either mealtime insulin aspart or bedtime insulin detemir treatment for 2 weeks. We assessed glucose variability indices, including M-value, SD of blood glucose level, and mean blood glucose (MBG) level. Flow-mediated dilation (FMD) of the brachial artery was measured as an index of endothelial function. Low-frequency power, high-frequency power, and the low-frequency to high-frequency power ratio (LF:HF ratio) derived via heart rate variability analysis using a Holter ECG were employed as indices of cardiac autonomic nerve function.
Results M-values and MBG levels showed a considerably greater decrease in the insulin aspart group than in the insulin detemir group (p=0.006 vs p=0.001); no change in FMD was observed in either group. Daytime LF:HF ratio significantly decreased in the insulin aspart group but not in the insulin detemir group. Total insulin dose at endpoint in the insulin aspart group was significantly higher than that in the insulin detemir group (p<0.001).
Conclusions Mealtime insulin aspart reduced glucose variability to a greater extent than bedtime insulin detemir in patients with type 2 diabetes. Despite the need for higher insulin doses, insulin aspart decreased daytime cardiac sympathetic nerve activity. These properties may subsequently help reduce cardiovascular risks.
Trial registration number UMIN000008369.
- insulin therapy
- postprandial hyperglycemia
- cardiac autonomic tone
- randomized controlled trial
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Footnotes
Presented at Parts of this study were presented in abstract form at the 4th Scientific Meeting of the Asian Association for the Study of Diabetes, Kyoto, Japan, November 24–27, 2012 (PCS-16-5).
Contributors TK and TT contributed to the study design, data collection, data analysis, and data interpretation, and drafted the manuscript. YT contributed to the study design and data collection. YI, KK, and HM contributed to the data collection. SK contributed to the study design and data interpretation. TT is the guarantor of this work, and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval This study was approved by the Ethics Committee of the Kanazawa University Hospital, Ishikawa, Japan, and was conducted in accordance with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.