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Augmented metabolic control improves myocardial diastolic function and perfusion in patients with non-insulin dependent diabetes
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  1. H von Bibra1,
  2. A Hansen1,
  3. V Dounis1,
  4. T Bystedt2,
  5. K Malmberg1,
  6. L Rydén1
  1. 1Department of Cardiology, Karolinska Hospital, Stockholm, Sweden
  2. 2Department of Endocrinology, Karolinska Hospital, Stockholm, Sweden
  1. Correspondence to:
    Professor Helene von Bibra
    Department of Endocrinology, Academic Hospital München-Bogenhausen, Englschalkingerstrasse 77, 81925 Munich, Germany; von-Bibraextern.lrz-muenchen.de

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Diastolic dysfunction and compromised myocardial blood flow are characteristic findings in patients with non-insulin dependent diabetes. We conducted a pilot trial to test the hypothesis that intensified metabolic control would improve myocardial function and perfusion in patients with non-insulin dependent diabetes.

DESIGN AND METHODS

Twenty five patients with non-insulin dependent diabetes (19 men, mean age 60 (9) years, diabetes duration 8 (7) years) were subjected to intensified metabolic control based on an increased dose of insulin (group A: n  =  16, fasting β glucose 11 (4) mmol/l) or of oral treatment (group B: n  =  9, fasting β glucose 11 (3) mmol/l). Exclusion criteria were a moderate to severe degree of diabetic microvascular complications, clinical signs of heart failure, valvar disease, severe hypertension, and concomitant hepatic or renal dysfunction. A further eight patients were studied as controls during unchanged medication (mean age 62 (6) years, fasting β glucose 8 (2) mmol/l).

Evidence of coronary artery disease was assessed based on coronary angiography or stress echocardiograms (dobutamine 10–40 mg/kg/min). All patients were trained to measure blood glucose with a reflectometer (Accutrend Sensor, Roche Diagnostics, Stockholm, Sweden). Self reported concentrations of fasting blood glucose averaged from three days before each visit served as a reference for glucose control. Myocardial perfusion and function were assessed by ultrasound technology at rest and during maximum vasodilatation (dipyridamole 0.84 mg/kg) before (visit 1) and three weeks after (visit 2) …

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