title: Effects of voglibose and nateglinide on glycemic status and coronary atherosclerosis in early-stage diabetic patients.
abstract: BACKGROUND
  Postprandial hyperglycemia and hyperinsulinemia have been considered as important determinants for the development of atherosclerosis. However, it remains to be elucidated whether correction of the postprandial glycemic status prevents atherosclerotic changes.
  
  
  RESULTS
  The DIANA (DIAbetes and diffuse coronary NArrowing) study is a prospective randomized open-label multicenter trial. The 302 patients with coronary artery disease (CAD), impaired glucose tolerance/diabetes mellitus (DM) pattern according to 75-g oral glucose tolerance test and HbA(1c) <6.9% were randomly assigned to life-style intervention (n=101), voglibose (0.9 mg/day, n=100) or nateglinide treatment (180 mg/day, n=101). We compared 1-year coronary atherosclerotic changes evaluated by quantitative coronary arteriography. Although voglibose significantly increased the number of patients with normal glucose tolerance at 1 year, there were no significant differences in coronary atherosclerotic changes at 1 year. However, overall, less atheroma progression was observed in patients in whom glycemic status was improved at 1 year (%change in total lesion length: 3.5% vs. 26.2%, P<0.01, %change in averaged lesion length: 0.7% vs. 18.6%, P=0.02).
  
  
  CONCLUSIONS
  Although coronary atherosclerotic changes were similar for voglibose and nateglinide, an improvement in glycemic status at 1 year was associated with less atheroma progression regardless of the treatment. Our findings underscore the management of glycemic abnormality to prevent coronary atherosclerotic changes in Japanese early-stage DM patients with CAD.
authors.affiliation: Department of Internal Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sase
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Yasunao
authors.initials: Y
authors.lastname: Yoshimasa
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control*; D003510:Cyclohexanes / Q000494:pharmacology* / Q000627:therapeutic use; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D038321:Glycemic Index / Q000187:drug effects*; D006801:Humans; D007004:Hypoglycemic Agents; D007294:Inositol / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077715:Nateglinide; D010649:Phenylalanine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D003510:Cyclohexanes; D007004:Hypoglycemic Agents; D000077715:Nateglinide; D010649:Phenylalanine; D007294:Inositol; C102817:voglibose