Effect of intensive insulin therapy on abnormal circadian blood pressure pattern in patients with type I diabetes mellitus.
OBJECTIVE
To assess the effect of tight glycemic control on the abnormal circadian BP pattern associated with IDDM.


METHODS
Retrospective, randomized control trial.


METHODS
Diabetes Research Institute, ambulatory.


METHODS
Seventy-four IDDM patients (22M/52F) on intensive subcutaneous insulin therapy (ISIT) were selected for this study.


METHODS
Group A patients (11M/25F) underwent, in addition to ISIT, weekly chronic intermittent intravenous insulin therapy (CIIIT) (TT Aoki et al, Lancet, 1993, 432:515-8). Group B patients (11M/27F) were continued on ISIT alone. All study patients were followed for 3 months on this regimen. They were seen weekly by the investigators and underwent monthly HbA1c determinations and 24-h ambulatory BP monitoring.


RESULTS
Glycemic control improved significantly in group A subjects (HbA1c decreased from 7.9% to 7.2%, p = 0.0002) but changed little in the group B subjects (p = NS). The night/day systolic BP ratio decreased from 0.97 to 0.94 (-3.10%) in group A and increased from 0.95 to 0.98 (+3.16%) in group B subjects (p = 0.224). The night/day diastolic ratio decreased from 0.93 to 0.90 (-3.23%) in group A and increased from 0.91 to 0.94 (+3.29%) in group B subjects (p = 0.0037).


CONCLUSIONS
CIIIT performed in IDDM patients on ISIT further improves their glycemic control and tends to reverse or at least prevent further deterioration of their abnormal circadian BP pattern.
Aoki
T T
TT
University of California, Division of Endocrinology, Davis, Sacramento 95817, USA.
Grecu
E O
EO
Arcangeli
M A
MA
Meisenheimer
R
R
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects*; D002940:Circadian Rhythm / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007328:Insulin / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies
D006442:Glycated Hemoglobin; D007328:Insulin