Two years of intensive glycemic control and left ventricular function in the Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM)

Two years of intensive glycemic control and left ventricular function in the Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM). S U Pitale , C Abraira , N V Emanuele , M McCarren , W G Henderson , I Pacold , D Bushnell , J A Colwell , F Q Nuttall , S R Levin , C T Sawin , J P...

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Veröffentlicht in:Diabetes care 2000-09, Vol.23 (9), p.1316-1320
Hauptverfasser: PITALE, S. U, ABRAIRA, C, SAWIN, C. T, COMSTOCK, J. P, SILBERT, C. K, EMANUELE, N. V, MCCARREN, M, HENDERSON, W. G, PACOLD, I, BUSHNELL, D, COLWELL, J. A, NUTTALL, F. Q, LEVIN, S. R
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Sprache:eng
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Zusammenfassung:Two years of intensive glycemic control and left ventricular function in the Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM). S U Pitale , C Abraira , N V Emanuele , M McCarren , W G Henderson , I Pacold , D Bushnell , J A Colwell , F Q Nuttall , S R Levin , C T Sawin , J P Comstock and C K Silbert Endocrinology and Diabetes Division, Hines VA Hospital, Illinois, USA. Abstract OBJECTIVE: The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM) was a multicenter randomized prospective study of 153 male type 2 diabetic patients to assess the ability to sustain clinically significant glycemic separation between intensive and standard treatment arms. A trend toward an excess of combined cardiovascular events in the intensive treatment arm of this trial was reported earlier. The present analysis was done to evaluate the effect of 2 years of intensive glycemic control on the left ventricular (LV) function. RESEARCH DESIGN AND METHODS: The patients were randomized to intensive step treatment with insulin alone or with sulfonylurea (intensive treatment arm [INT], n = 75) or to standard once-daily insulin injection (standard treatment arm [STD], n = 78) treatment. A total of 136 patients (standard treatment arm [STD], n = 70; INT, n = 66) had radionuclide ventriculography at entry and at 24 months for the assessment of LV function. RESULTS: There was no difference in the mean LV ejection fraction (at entry: STD 57.1+/-9.51%; INT 58.1+/-8.7%; at 24 months: STD 57.3+/-10.8%, INT 59.5+/-10.7%), peak filling rate (at entry: STD 2.6+/-0.7 end diastolic volume per second, INT 2.4+/-0.8 end diastolic volume per second; at 24 months: STD 2.7+/-1.0 end diastolic volume per second, INT 2.5+/-0.7 end diastolic volume per second), or time to peak filling rate (at entry: STD 195.3+/-69.5 ms, INT 185.6 +/-62.4 ms; at 24 months: STD 182.6+/-64.8 ms, INT 179.2+/-61.2 ms) between the 2 treatment arms. A subgroup analysis of 104 patients (STD, n = 53; INT, n = 51) that omitted individuals with intervening cardiac events/revascularization or a change in cardioactive medications also showed no difference in the LV function at entry and at 24 months between the 2 groups. Abnormal LV ejection fraction at baseline predicted cardiac events (interval between cardiac beats [RR] = 2.5). CONCLUSIONS: Two years of intensive glycemic control does not affect the LV systolic or diastolic function in patients with type 2 diabetes.
ISSN:0149-5992
1935-5548
DOI:10.2337/diacare.23.9.1316