Related Experiment Videos
Early atherosclerosis is retarded by improved long-term blood glucose control in patients with IDDM
K J Jensen-Urstad1, P G Reichard, J S Rosfors
1Department of Clinical Physiology, Södersjukhuset, Stockholm, Sweden.
Insights
Improved blood glucose control in patients with insulin-dependent diabetes mellitus (IDDM) slows the development of atherosclerosis. Intensified conventional insulin treatment (ICT) significantly reduced arterial stiffness and intima-media thickness compared to standard treatment (ST).
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Metabolic Diseases
Background:
- Microangiopathy in insulin-dependent diabetes mellitus (IDDM) is known to improve with better blood glucose control.
- The effect of glycemic control on macroangiopathy, specifically atherosclerosis, in IDDM patients remains less clear.
- Atherosclerosis is a major complication and risk factor for cardiovascular events in diabetic populations.
Purpose of the Study:
- To investigate the impact of intensified conventional insulin treatment (ICT) versus standard treatment (ST) on macrovascular complications in IDDM patients.
- To assess the relationship between long-term glycemic control (HbA1c) and markers of atherosclerosis, including endothelial function, intima-media thickness, and arterial stiffness.
Main Methods:
- A total of 59 IDDM patients were divided into two groups: 31 on ICT and 28 on ST over 10 years.
- Blood glucose control was monitored via HbA1c levels.
- Vascular parameters were assessed using high-frequency ultrasound, measuring brachial artery flow-mediated dilation, carotid artery plaques, intima-media thickness, and arterial wall stiffness.
Main Results:
- The ICT group achieved significantly better long-term glycemic control (HbA1c 7.1%) compared to the ST group (HbA1c 8.2%).
- Patients in the ST group exhibited stiffer arteries and thicker carotid intima-media compared to the ICT group.
- Lower HbA1c levels were consistently associated with improved endothelial function and reduced arterial stiffness.
Conclusions:
- Intensified conventional insulin treatment, leading to better blood glucose control, significantly retards the development of atherosclerosis in IDDM patients.
- Improved glycemic management in IDDM benefits not only microvascular but also macrovascular health, reducing cardiovascular risk.
- Long-term studies demonstrate a clear link between sustained lower HbA1c and improved vascular function, highlighting the importance of tight glucose control.
Abstract:
Microangiopathy is retarded by improved blood glucose control in patients with IDDM. Whether or not this is true for macroangiopathy (atherosclerosis) has remained unclear. A total of 59 patients (44 +/- 1.5 years, previous HbA1C 9.4 +/- 0.2%, mean +/- SE) with IDDM were investigated. Of the 59 patients, 31 had been randomized to long-term intensified conventional insulin treatment (ICT), and the remaining 28 had received standard insulin treatment (ST). Blood glucose control was significantly better in the ICT patients with an HbAlc value (mean of 29 values during 10 years) of 7.1 +/- 0.1% compared with the ST patients' 8.2 +/- 0.2% (P < 0.0001). With high-frequency ultrasound, endothelial function was measured as flow-mediated dilation of the right brachial artery. The carotid arteries were scanned for plaques, intima-media thickness was measured, and arterial wall stiffness was calculated in the right common carotid artery. These measurements correlate with manifest and/or risk factors for coronary atherosclerosis. The patients in the ST group had stiffer arteries (P = 0.011) and thicker intima-media in the left common carotid artery (P = 0.009) than those in the ICT group. Patients with lower HbA1c generally had better endothelial function (P = 0.028) and less stiff arteries (P = 0.009). Better blood glucose control in patients with IDDM is related not only to less microangiopathy but also to a slower development of atherosclerosis.