Abstract | BACKGROUND: It is unknown whether changes in circulating glucose levels due to short-term insulin discontinuation affect left ventricular contractile function in type 2 diabetic patients with (T2D-HF) and without (T2D-nonHF) heart failure. MATERIALS AND METHODS: In two randomized cross-over-designed trials, 18 insulin-treated type 2 diabetic patients with (Ejection Fraction (EF) 36 ± 6%, n = 10) (trial 2) and without systolic heart failure (EF 60 ± 3%, n = 8) (trial 1) were subjected to hyper- and normoglycemia for 9-12 hours on two different occasions. Advanced echocardiography, bicycle exercise tests and 6-minute hall walk distance were applied. RESULTS: Plasma glucose levels differed between study arms (6.5 ± 0.8 mM vs 14.1 ± 2.6 mM (T2D-HF), 5.8 ± 0.4 mM vs 9.9 ± 2.1 mM (T2D-nonHF), p<0.001). Hyperglycemia was associated with an increase in several parameters: maximal global systolic tissue velocity (Vmax) (p<0.001), maximal mitral annulus velocity (S'max) (p<0.001), strain rate (p = 0.02) and strain (p = 0.05). Indices of increased myocardial systolic contractile function were significant in both T2D-HF (Vmax: 14%, p = 0.02; S'max: 10%, p = 0.04), T2D-nonHF (Vmax: 12%, p<0.01; S'max: 9%, p<0.001) and in post exercise S'max (7%, p = 0.049) during hyperglycemia as opposed to normoglycemia. LVEF did not differ between normo- and hyperglycemia (p = 0.17), and neither did peak exercise capacity nor catecholamine levels. Type 2 diabetic heart failure patients' 6-minute hall walk distance improved by 7% (p = 0.02) during hyperglycemia as compared with normoglycemia. CONCLUSIONS: Short-term hyperglycemia by insulin discontinuation is associated with an increase in myocardial systolic contractile function in type 2 diabetic patients with and without heart failure and with a slightly prolonged walking distance in type 2 diabetic heart failure patients. (Clinicaltrials.gov identifier NCT00653510).
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Authors | Roni Nielsen, Helene Nørrelund, Ulla Kampmann, Hans Erik Bøtker, Niels Møller, Henrik Wiggers |
Journal | PloS one
(PLoS One)
Vol. 8
Issue 1
Pg. e53247
( 2013)
ISSN: 1932-6203 [Electronic] United States |
PMID | 23308171
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Blood Glucose
- Hypoglycemic Agents
- Insulin
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Topics |
- Aged
- Blood Glucose
(analysis)
- Cross-Over Studies
- Diabetes Mellitus, Type 2
(blood, complications)
- Echocardiography
- Female
- Heart Failure, Systolic
(blood, complications, physiopathology)
- Heart Ventricles
(physiopathology)
- Hemodynamics
- Humans
- Hyperglycemia
(blood, complications)
- Hypoglycemic Agents
(therapeutic use)
- Insulin
(therapeutic use)
- Male
- Middle Aged
- Myocardial Contraction
- Ventricular Function, Left
- Walking
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