Effects of Insulin Dependence on Inflammatory Process, Thrombotic Mechanisms and Endothelial Function, in Patients with Type 2 Diabetes Mellitus and Coronary Atherosclerosis

Effects of Insulin Dependence on Inflammatory Process, Thrombotic Mechanisms and Endothelial... Background Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction, increased thrombogeneisity and abnormal inflammatory response. Hypothesis We hypothesizsed that insulin dependence/exogenous insulin administration may affect thrombotic/inflammatory status and endothelial function in patients with T2DM and coronary artery disease (CAD). Methods Fifty‐five patients with T2DM + CAD (26 insulin‐treated (INS) and 29 under oral biguanide + sulphonylurea (TABL)) were recruited. Endothelial function was assessed by gauge‐strain plethysmography, and serum levels of inflammatory and thrombotic markers were determined by enzyme linked immunosorbent assay. Results There was no significant difference in endothelium‐dependent dilation (EDD) between the study groups, while EDD was correlated with fasting glucose levels in both INS (r = − 0.776, p = 0.0001) and TABL (r = − 0.702, p = 0.0001). Patients in INS group had higher levels of interleukin‐6 (IL‐6), tumor necrosis factor alpha (TNF‐α), monocyte chemoattractant protein (MCP‐1) and vascular cell adhesion molecule (sVCAM‐1), compared to TABL. However, TNF‐α was negatively correlated with protein C (PrtC) only in INS (r = − 0.726, p = 0.01) but not in TABL group (r = − 0.066, p = 0.738). Similarly, sVCAM‐1 was correlated with PrtC only among INS patients (r = − 0.451, p = 0.046) but not in TABL (r = 0.069, p = 0.727). In multivariate analysis, insulin dependence was a predictor of IL‐6, TNF‐α, MCP‐1 and sVCAM‐1 levels independently from the patients' demographic characteristics, the angiographic extend of CAD or the duration of diabetes. Conclusions Insulin treatment in patients with type 2 diabetes mellitus affects the expression of inflammatory cytokines and subsequently modifies the thrombotic mechanisms in patients with coronary atherosclerosis, independently from the duration of diabetes and the extend of coronary artery disease. Copyright © 2007 Wiley Periodicals, Inc. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical Cardiology Wiley

Effects of Insulin Dependence on Inflammatory Process, Thrombotic Mechanisms and Endothelial Function, in Patients with Type 2 Diabetes Mellitus and Coronary Atherosclerosis

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Abstract

Background Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction, increased thrombogeneisity and abnormal inflammatory response. Hypothesis We hypothesizsed that insulin dependence/exogenous insulin administration may affect thrombotic/inflammatory status and endothelial function in patients with T2DM and coronary artery disease (CAD). Methods Fifty‐five patients with T2DM + CAD (26 insulin‐treated (INS) and 29 under oral biguanide + sulphonylurea (TABL)) were recruited. Endothelial function was assessed by gauge‐strain plethysmography, and serum levels of inflammatory and thrombotic markers were determined by enzyme linked immunosorbent assay. Results There was no significant difference in endothelium‐dependent dilation (EDD) between the study groups, while EDD was correlated with fasting glucose levels in both INS (r = − 0.776, p = 0.0001) and TABL (r = − 0.702, p = 0.0001). Patients in INS group had higher levels of interleukin‐6 (IL‐6), tumor necrosis factor alpha (TNF‐α), monocyte chemoattractant protein (MCP‐1) and vascular cell adhesion molecule (sVCAM‐1), compared to TABL. However, TNF‐α was negatively correlated with protein C (PrtC) only in INS (r = − 0.726, p = 0.01) but not in TABL group (r = − 0.066, p = 0.738). Similarly, sVCAM‐1 was correlated with PrtC only among INS patients (r = − 0.451, p = 0.046) but not in TABL (r = 0.069, p = 0.727). In multivariate analysis, insulin dependence was a predictor of IL‐6, TNF‐α, MCP‐1 and sVCAM‐1 levels independently from the patients' demographic characteristics, the angiographic extend of CAD or the duration of diabetes. Conclusions Insulin treatment in patients with type 2 diabetes mellitus affects the expression of inflammatory cytokines and subsequently modifies the thrombotic mechanisms in patients with coronary atherosclerosis, independently from the duration of diabetes and the extend of coronary artery disease. Copyright © 2007 Wiley Periodicals, Inc.

Journal

Clinical CardiologyWiley

Published: Jun 1, 2007

References

  • Insulin treatment and cardiovascular disease; friend or foe? A point of view
    Muis, Muis; Bots, Bots; Grobbee, Grobbee; Stolk, Stolk
  • Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention
    Unwin, Unwin; Shaw, Shaw; Zimmet, Zimmet; Alberti, Alberti
  • The anti‐inflammatory and potential anti‐atherogenic effect of insulin: a new paradigm
    Dandona, Dandona; Aljada, Aljada; Mohanty, Mohanty
  • Randomized trial of insulin‐glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year
    Malmberg, Malmberg; Ryden, Ryden; Efendic, Efendic; Herlitz, Herlitz; Nicol, Nicol

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