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A decrease in glucose variability does not reduce cardiovascular event rates in type 2 diabetic patients after acute
Sarah E Siegelaar1, Lisa Kerr, Scott J Jacober
1Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands. s.e.siegelaar@amc.uva.nl
Diabetes Care
|March 31, 2011
Summary
Targeting postprandial hyperglycemia (PRANDIAL) reduced glucose variability (GV) in type 2 diabetes patients post-myocardial infarction. However, this strategy did not lower cardiovascular outcomes, questioning the benefit of targeting GV.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Intraday glucose variability (GV) is a potential risk factor for cardiovascular events in type 2 diabetes mellitus (T2DM) patients post-myocardial infarction (MI).
- The HEART2D study previously investigated the effects of different insulin strategies on cardiovascular outcomes in this population.
Purpose of the Study:
- To reanalyze the HEART2D study data to assess the impact of intraday GV on cardiovascular outcomes.
- To compare the effects of a postprandial (PRANDIAL) versus a basal (BASAL) insulin targeting strategy on GV and secondary cardiovascular events.
Main Methods:
- Reanalysis of data from the HEART2D study involving T2DM patients post-MI.
- Patients were randomized to PRANDIAL (n=557) or BASAL (n=558) insulin strategies.
- GV was quantified using mean amplitude of glycemic excursions (MAGE), mean absolute glucose (MAG) change, and standard deviation (SD).
Main Results:
- The PRANDIAL strategy significantly reduced MAG by 18% compared to BASAL (P=0.02).
- MAGE and SD were lower in the PRANDIAL group, but these differences were not statistically significant.
- HbA1c levels and cardiovascular event rates were similar between the PRANDIAL and BASAL groups.
Conclusions:
- A PRANDIAL insulin strategy effectively reduced intraday GV compared to a BASAL strategy.
- Despite reduced GV, the PRANDIAL strategy did not lead to a significant reduction in cardiovascular outcomes.
- The findings do not support the hypothesis that targeting intraday GV is beneficial for reducing secondary cardiovascular events in T2DM patients post-MI.
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