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Improvement of glycaemic control in type 2 diabetes: favourable changes in blood pressure, total cholesterol and triglycerides, but not in HDL cholesterol, fibrinogen, Von Willebrand factor and (pro)insulin.
Neth J Med 2003; 61(4):129-36NJ

Abstract

BACKGROUND

Diabetes mellitus causes a substantial increase in cardiovascular risk, which can only partly be reduced by antihyperglycaemic treatment. We were interested in whether improvement in glycaemic control is associated with improvement of other cardiovascular risk factors. Therefore, we studied among type 2 diabetic patients the association between on the one hand changes in glycaemic control and on the other hand within-subject changes of both classic cardiovascular risk factors and less conventional cardiovascular risk indicators that are typically associated with type 2 diabetes (proinsulin, insulin, fibrinogen, von Willebrand factor and the urinary albumin-creatinine ratio).

METHODS

The 214 type 2 diabetic patients were randomly assigned to either a strict fasting capillary glucose target level (< 6.5 mmol/l) or a less strict target (< 8.5 mmol/l). Duration of follow-up was two years. Since the interventions did not yield statistically significant differences between the treatment arms, we reanalysed the data focusing on within-subject changes of cardiovascular risk factors and indicators across tertiles of average HbA(1c).

RESULTS

Individuals in whom HbA(1c) decreased had significant favourable concurrent changes in triglycerides, total cholesterol, blood pressure, and in the albumin-creatinine ratio in those who were normoalbuminuric at baseline. In contrast, these individuals had unfavourable, although not statistically significant, changes in HDL cholesterol, proinsulin, insulin, fibrinogen and von Willebrand factor. In the whole group, fibrinogen increased more than could be expected on the basis of the relationship between fibrinogen and age, namely from 3.5 +/- 0.8 to 3.9 +/- 0.9 g/l (p value < 0.01).

CONCLUSIONS

Our results suggest that improvement in glycaemia in type 2 diabetes is associated with significant favourable changes in triglycerides, total cholesterol, blood pressure and, in normoalbuminuric individuals, albumin-creatinine ratio. In contrast, it is not consistently associated with favourable changes in some cardiovascular risk indicators typically associated with diabetes, which may in part explain why antihyperglycaemic treatment does not clearly lower atherothrombotic disease risk.

Authors+Show Affiliations

Institute for Research in Extramural Medicine, Free University Medical Centre, De Boelelaan 1117, 1008 HV Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12852722

Citation

Becker, A, et al. "Improvement of Glycaemic Control in Type 2 Diabetes: Favourable Changes in Blood Pressure, Total Cholesterol and Triglycerides, but Not in HDL Cholesterol, Fibrinogen, Von Willebrand Factor and (pro)insulin." The Netherlands Journal of Medicine, vol. 61, no. 4, 2003, pp. 129-36.
Becker A, van der Does FE, van Hinsbergh VW, et al. Improvement of glycaemic control in type 2 diabetes: favourable changes in blood pressure, total cholesterol and triglycerides, but not in HDL cholesterol, fibrinogen, Von Willebrand factor and (pro)insulin. Neth J Med. 2003;61(4):129-36.
Becker, A., van der Does, F. E., van Hinsbergh, V. W., Heine, R. J., Bouter, L. M., & Stehouwer, C. D. (2003). Improvement of glycaemic control in type 2 diabetes: favourable changes in blood pressure, total cholesterol and triglycerides, but not in HDL cholesterol, fibrinogen, Von Willebrand factor and (pro)insulin. The Netherlands Journal of Medicine, 61(4), pp. 129-36.
Becker A, et al. Improvement of Glycaemic Control in Type 2 Diabetes: Favourable Changes in Blood Pressure, Total Cholesterol and Triglycerides, but Not in HDL Cholesterol, Fibrinogen, Von Willebrand Factor and (pro)insulin. Neth J Med. 2003;61(4):129-36. PubMed PMID: 12852722.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement of glycaemic control in type 2 diabetes: favourable changes in blood pressure, total cholesterol and triglycerides, but not in HDL cholesterol, fibrinogen, Von Willebrand factor and (pro)insulin. AU - Becker,A, AU - van der Does,F E E, AU - van Hinsbergh,V W M, AU - Heine,R J, AU - Bouter,L M, AU - Stehouwer,C D A, PY - 2003/7/11/pubmed PY - 2003/7/30/medline PY - 2003/7/11/entrez SP - 129 EP - 36 JF - The Netherlands journal of medicine JO - Neth J Med VL - 61 IS - 4 N2 - BACKGROUND: Diabetes mellitus causes a substantial increase in cardiovascular risk, which can only partly be reduced by antihyperglycaemic treatment. We were interested in whether improvement in glycaemic control is associated with improvement of other cardiovascular risk factors. Therefore, we studied among type 2 diabetic patients the association between on the one hand changes in glycaemic control and on the other hand within-subject changes of both classic cardiovascular risk factors and less conventional cardiovascular risk indicators that are typically associated with type 2 diabetes (proinsulin, insulin, fibrinogen, von Willebrand factor and the urinary albumin-creatinine ratio). METHODS: The 214 type 2 diabetic patients were randomly assigned to either a strict fasting capillary glucose target level (< 6.5 mmol/l) or a less strict target (< 8.5 mmol/l). Duration of follow-up was two years. Since the interventions did not yield statistically significant differences between the treatment arms, we reanalysed the data focusing on within-subject changes of cardiovascular risk factors and indicators across tertiles of average HbA(1c). RESULTS: Individuals in whom HbA(1c) decreased had significant favourable concurrent changes in triglycerides, total cholesterol, blood pressure, and in the albumin-creatinine ratio in those who were normoalbuminuric at baseline. In contrast, these individuals had unfavourable, although not statistically significant, changes in HDL cholesterol, proinsulin, insulin, fibrinogen and von Willebrand factor. In the whole group, fibrinogen increased more than could be expected on the basis of the relationship between fibrinogen and age, namely from 3.5 +/- 0.8 to 3.9 +/- 0.9 g/l (p value < 0.01). CONCLUSIONS: Our results suggest that improvement in glycaemia in type 2 diabetes is associated with significant favourable changes in triglycerides, total cholesterol, blood pressure and, in normoalbuminuric individuals, albumin-creatinine ratio. In contrast, it is not consistently associated with favourable changes in some cardiovascular risk indicators typically associated with diabetes, which may in part explain why antihyperglycaemic treatment does not clearly lower atherothrombotic disease risk. SN - 0300-2977 UR - https://www.unboundmedicine.com/medline/citation/12852722/Improvement_of_glycaemic_control_in_type_2_diabetes:_favourable_changes_in_blood_pressure_total_cholesterol_and_triglycerides_but_not_in_HDL_cholesterol_fibrinogen_Von_Willebrand_factor_and__pro_insulin_ L2 - http://www.njmonline.nl/njm/getarticle.php?v=61&amp;i=4&amp;p=129 DB - PRIME DP - Unbound Medicine ER -