Improvement of postprandial hyperglycemia has a positive impact on epicardial flow of entire coronary tree in acute coronary syndromes patients

Single administration of alpha-glucosidase inhibitors on endothelial function and incretin secretion in diabetic patients with coronary artery disease - Juntendo University trial: effects of miglitol on endothelial vascular reactivity in type 2 diabetic patients with coronary heart disease (J-MACH) -

BACKGROUND

Post-prandial hyperglycemia, hyperlipidemia, and endothelial dysfunction play an important role in the pathogenesis of atherosclerosis. Improvement in post-prandial hyperglycemia on alpha-glucosidase inhibitors (alpha-GIs) is associated with a risk reduction of cardiovascular diseases, but the post-prandial effects of alpha-GIs on endothelial function and incretin secretion in type 2 diabetic patients with coronary artery disease (CAD) remain unclear.

METHODS AND RESULTS

The post-prandial effects of a single administration of miglitol and voglibose on endothelial function and changing levels of glucose, insulin, lipids, glucagon-like peptide (GLP)-1, and gastric inhibitory polypeptide (GIP) were compared after a standard meal loading in 11 diabetic patients with CAD, using a placebo-controlled cross-over design. The changing levels of glucose, insulin and triglycerides at 60 min were significantly lower in the miglitol group than in the voglibose and placebo groups (all P<0.01). GLP-1 levels were significantly higher at 120 min (P<0.05) and GIP levels were significantly lower at 30 min and 60 min (P<0.05) in the miglitol group compared to other treatments. The reactive hyperemia duration at 120 min was significantly maintained in the miglitol group compared to the other groups.

CONCLUSIONS

A single administration of miglitol significantly improved post-prandial glucose/lipid metabolism, incretin secretion, and endothelial dysfunction in diabetic patients with CAD, suggesting that miglitol may be a useful anti-atherogenic agent (UMIN000002264).

Influence of admission plasma glucose level on short- and long-term prognosis in patients with ST-segment elevation myocardial infarction

BACKGROUND/AIM

Hyperglicemia is common in patients with ST-elevation myocardial infarction (STEMI) and is associated with high risk of mortality and morbidity. Relationship between admission plasma glucose (APG) levels and mortality in diabetic and nondiabetic patients with STEMI needs further investigation. The aim of this study was to analyse the short- and long-term prognostic significance of APG levels in patients with STEMI with and without diabetes.

METHODS

This study included 115 patients with STEMI, 86 (74.8%) nondiabetic and 29 (25.2%) dibaetic patients, in which we performed a prospective analysis of the relationship between APG levels and short- and long-term mortality.

RESULTS

Comparison of APG levels between nondiabetic (8.32 +/- 2.4 mmol/L) and diabetic (10.09 +/- 2.5 mmol/L) patients showed statistically significantly higher average APG levels in diabetic patients (p = 0.001). In all patients observed who died either after one month or one year after STEMI, average APG values were significantly higher in comparison with those in survived patients. There was no statistical significance in average APG levels in the diabetic patients with STEMI who died after one month and those who survived (10.09 +/- 2.68 vs 10.0 +/- 2.51 mmol/L, respectively; p = 0.657), as well as those who died after one year and those who survived (10.1 +/- 1.92 vs 10.09 +/- 2.8 mmol/L, respectively; p = 0.996). There was, however, statistical significance in average APG levels in the nondiabetic patients with STEMI who died after one month and those who survived (9.97 +/- 2.97 vs 7.91 +/- 2.08 mmol/L, respectively; p = 0.001), as well as those who died after one year and those who survived (9.17 +/- 2.49 vs 7.84 +/- 2.24 mmol/L, respectively; p = 0.013).

CONCLUSION

Acute hyperglicemia in the settings of STEMI worsenes the prognosis in patients with and without diabetes. Our study showed that nondiabetic patients with high APG levels are at higher risk of mortality than patients with a known history of diabetes.

Type 2 diabetes: postprandial hyperglycemia and increased cardiovascular risk

Hyperglycemia is a major risk factor for both the microvascular and macrovascular complications in patients with type 2 diabetes. This review summarizes the cardiovascular results of large outcomes trials in diabetes and presents new evidence on the role of hyperglycemia, with particular emphasis on postprandial hyperglycemia, in adverse cardiovascular outcomes in patients with type 2 diabetes. Treatment options, including the new dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 mimetics that primarily target postprandial hyperglycemia, are also discussed. Hyperglycemia increases cardiovascular mortality, and reducing hyperglycemia lowers cardiovascular risk parameters. Control of both fasting and postprandial hyperglycemia is necessary to achieve optimal glycated hemoglobin control. Therefore, anti-hyperglycemic agents that preferentially target postprandial hyperglycemia, along with those that preferentially target fasting hyperglycemia, are strongly suggested to optimize individual diabetes treatment strategies and reduce complications.

Assessment of coronary artery flow velocity pattern as a long-term predictor of left ventricular function and cardiac events after percutaneous coronary intervention in anterior acute myocardial infarction

BACKGROUND

Coronary flow velocity (CFV) can be used to assess short-term left ventricular function recovery and the clinical prognosis of patients with acute myocardial infarction (AMI). We evaluated CFV as a predictor of long-term left ventricular function recovery and cardiac events in patients with anterior wall AMI.

METHODS AND RESULTS

CFV pattern of the distal left anterior descending (LAD), wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) were recorded at the points of time within 24 hours, 3 days, 6 months, and 3 years after percutaneous coronary intervention (PCI) in 50 consecutive patients with anterior wall AMI. The clinical data were collected. Patients were divided into two groups based on diastolic deceleration time (DDT) 3 days after PCI. Compared with 3 days, LVEF and WMSI in group A (DDT>600 ms, n=20) improved in 6 months and 3 years (p<0.01), but they were unchanged in group B (DDT< or =600 ms, n=30). The incidence of cardiac events was higher in group B than in group A during 6 months (p<0.01).With a 3-year follow up, the incidence of chronic heart failure was higher in group B than in group A (p=0.009).

CONCLUSION

CFV could be used as a predictor of long-term left ventricular function recovery and cardiac events in patients with anterior wall AMI.

Can blood glucose self-monitoring improve treatment outcomes in type 2 diabetes?

BACKGROUND

Increased cardiovascular risk in diabetes cannot be attributed to the higher prevalence of classic risk factors.

IMPORTANCE OF POSTPRANDIAL HYPERGLYCEMIA

Most of the cardiovascular risk factors have shown to be directly related to the degree of postprandial glycemia (PPG). PPG should be recognized as a marker for the increased risk of cardiovascular disease.

ASSESSMENT OF TARGETS FOR GLYCEMIA CONTROL

Two important methods available-self-monitoring of blood glucose (SMBG) reveals immediate hour-to-hour blood glucose, while long-term glycemia is assessed by HbA1c. Reducing PPG and glycemia excursions is as important as lowering fasting plasma glucose and HbA1c levels.

EFFECTIVENESS OF SMBG

SMBG plays a key role in diabetes care, and has proven to be effective for insulin treated type 2 diabetic patients. Debate continues on the effectiveness of SMBG in non-insulin treated type 2 diabetes. Whether non-insulin treated type 2 diabetic patients benefit from SMBG, a large-scale randomized controlled trial with the follow-up period to investigate long-term effects should be carried out. A general recommendation is that insulin treated patients perform SMBG at least three times per day. SMBG frequency for non-insulin users should be individualized to treatment regimen and level of control.

The relationship between endothelial dysfunction and oxidative stress in diabetes and prediabetes

OBJECTIVE

Diabetes mellitus is associated with endothelial dysfunction and oxidative stress (OS). The aim of the present study was to determine whether increased OS and impaired endothelial function, are present in early states of diabetes, such as impaired glucose tolerance (IGT) and impaired fasting glucose (IFG).

METHODS

Brachial artery flow-mediated dilatation (FMD) and nitrate-induced dilatation were measured in 133 subjects with carbohydrate abnormalities (45 IGT, 44 IFG and 44 Type 2 diabetes mellitus) and in 46 subjects with normal glucose tolerance (NGT). Waist circumference, body mass index, blood pressure and fasting lipid profiles were obtained, and glucose and insulin values in response to a 75-g oral glucose load were also measured. Plasma malondialdehyde (MDA) and superoxide dismutase (SOD) activity were determined.

RESULTS

Patients with diabetes and prediabetes had a higher plasma MDA concentration, but a lower plasma SOD activity than the NGT group (p = 0.006) and SOD activity was positively associated with FMD (p = 0.039). FMD were significantly reduced in the groups of subjects with abnormal carbohydrate metabolism compared with the NGT group (p = 0.035). Among the subjects with diabetes and prediabetes, FMD showed a negative correlation with fasting glucose and/or plasma glucose level at 120 min after oral glucose tolerance test (p = 0.028).

CONCLUSIONS

The results showed that endothelial dysfunction and increased OS were present in subjects with IGT and IFG, indicating endothelial damage in these stages.