Abstract:
INTRODUCTION:Diabetic cardiac autonomic neuropathy (CAN) is potentially life threatening and its severity might further be aggravated by poor glycaemic control. A decrease in Heart rate variability (HRV) is the earliest finding of CAN even at the sub clinical stage. While intensive glycaemic control prevents the development of CAN in patients with type 1 diabetes, it is not known whether the intensification of glycaemic control using insulin would improve cardiovascular autonomic functions in type 2 diabetes patients. This study aimed to determine the short term effects of optimizing glycaemic control using insulin on the HRV in type 2 diabetes patients. METHODS:We conducted a single arm open label clinical trial. Participants were poorly controlled non-insulin treated type 2 diabetes mellitus patients (HbA1c ≥ 7%). The intervention lasted 60 days and consisted in the intensification of glycaemic control through the initiation of a basal plus insulin regimen with titration of insulin to protocol defined glycaemic targets which were; fasting glycaemia: 0.70-1.30 g/L and post prandial glycaemia <1.80 g/L. Long term HRV measurement was done using a 24-h ambulatory electrocardiographic (ECG) recording on day 0 and day 60. Wilcoxon signed rank test was used to compare differences in HRV parameters before and after the intervention. RESULTS:A total of 29 (14 males and 15 females) consenting type 2 diabetes mellitus patients without clinical signs of CAN were enrolled and allocated to intervention (14 males and 15 females). The median age was 52 [43-59] years, and duration of diabetes 3.0 [0.6-6.7] years. The intervention induced a reduction in HbA1c from 10.1 [9.1-11.9]% to 6.7 [5.9-6.9]% (p < 0.001) without severe hypoglycaemic events. Concerning HRV parameters, there was a significant improvement in markers of the parasympathetic tone (PNN50: 5.7 [3.6-10.3]% to 8.1 [3.1-16.9]%, p = 0.008) and sympathetic tone (SDNN: 102.01 [90.45-111.05] ms to 122.40 [91.70-135.95] ms, p = 0.01). CONCLUSION:The optimization of glycaemic control using a basal plus insulin regimen while inducing a significant reduction in glycated hemoglobin, significantly improves 24-h ambulatory ECG derived sympathetic and parasympathetic activities. This suggests that tight glycaemic control using insulin may revert cardiac autonomic neuropathy in type 2 diabetes mellitus patients.
journal_name
Diabetes Res Clin Practjournal_title
Diabetes research and clinical practiceauthors
Mba CM,Nganou-Gnindjio CN,Azabji-Kenfack M,Mfeukeu-Kuate L,Dehayem MY,Mbanya JC,Sobngwi Edoi
10.1016/j.diabres.2019.107875subject
Has Abstractpub_date
2019-11-01 00:00:00pages
107875eissn
0168-8227issn
1872-8227pii
S0168-8227(19)30301-8journal_volume
157pub_type
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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abstract::Rye flakes, rye bread and white wheat bread were given as suspensions to rats and in standardized breakfast meals to non-insulin-dependent diabetics. In both cases the postprandial glucose response was lower after rye bread than after wheat bread. A larger amount of starch remained in the stomach of the rats 15 min af...
journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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journal_title:Diabetes research and clinical practice
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pub_type: 杂志文章,随机对照试验
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journal_title:Diabetes research and clinical practice
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doi:10.1016/j.diabres.2004.05.013
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journal_title:Diabetes research and clinical practice
pub_type: 杂志文章
doi:
更新日期:1996-10-01 00:00:00
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journal_title:Diabetes research and clinical practice
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更新日期:1990-01-01 00:00:00
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更新日期:2020-10-01 00:00:00
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journal_title:Diabetes research and clinical practice
pub_type: 杂志文章
doi:10.1016/j.diabres.2007.02.002
更新日期:2007-09-01 00:00:00
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