Endothelial function in patients with newly diagnosed type 2 diabetes receiving early intensive insulin therapy.
BACKGROUND
Multifactorial intervention is unable to improve endothelial dysfunction/cardiovascular outcome in type 2 diabetes. Intensive insulin therapy improves pancreatic β-cell dysfunction in patients with early stage diabetes. We investigated the effect of intensive insulin therapy on endothelial dysfunction in these patients.


METHODS
One hundred and sixteen patients with newly diagnosed type 2 diabetes and 59 healthy subjects received flow-mediated dilatation (FMD) and von Willebrand factor (vWF) measurement. Diabetic patients were further treated with either multifactorial intervention (group A), or intensive insulin therapy (group B) for 2 weeks. Both FMD and vWF measurement were repeated at the same time. FMD was reassessed 90 days after intervention.


RESULTS
Compared with healthy subjects, FMD in diabetic patients was significantly lower (group A: 15.99 ± 7.81 % vs. 25.17 ± 7.12 %, P < 0.01; group B: 16.85 ± 7.30 % vs. 25.17 ± 7.12%, P < 0.01), plasma vWF was significantly higher (group A: 224.34 ± 7.36 U/l vs. 109.69 ± 6.30 U/l, P < 0.01; group B: 219.18 ± 6.92 U/l vs. 109.69 ± 6.30 U/l, P < 0.01). After treatment, there was no significant change of FMD in either group. The vWF did not change after multifactorial intervention (220.96 ± 6.85 U/l vs. 224.34 ± 7.36 U/l, P = 0.49), but significantly decreased after intensive insulin therapy (155.08 ± 11.82 U/l vs. 219.18 ± 6.92 U/l, P = 0.0013).


CONCLUSIONS
Intensive insulin therapy significantly improves endothelial injury/dysfunction as measured by vWF in early stage type 2 diabetes. Further study is needed to determine whether plasma vWF can help early identification, stratification and management of diabetic endothelial dysfunction.
Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
Jing
J
Tian
Jingfeng
J
Wang
Yan
Y
Li
Daniel
D
Villarreal
Robert
R
Carhart
Yanbin
Y
Dong
Yanling
Y
Wen
Kan
K
Liu
D000328:Adult; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation / Q000187:drug effects*; D014841:von Willebrand Factor / Q000378:metabolism
D000959:Antihypertensive Agents; D015415:Biomarkers; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D014841:von Willebrand Factor