To evaluate whether treatment with insulin analogues is associated with a lower risk of hypoglycaemia (HYPO score) and less glycaemic variability (Lability Index) than treatment with human insulin in ...patients with type 1 diabetes. In a 6-month prospective, open-labelled trial, we randomized 47 patients treated with human insulin to receive treatment with human insulin (
n
= 21) or insulin analogues (
n
= 26). HYPO score, Lability Index (LI), and hypoglycaemic episode characteristics were assessed at baseline and at the end of follow-up. A 72-h, continuous glucose monitoring was performed at the end in a subgroup of patients. Groups were compared with nonparametric tests. Significance was defined as
P
< 0.05. HYPO score (71.5 36.0–162 vs. 260 52.0–676,
P
< 0.05), nocturnal hypoglycaemia (0.4 vs. 1.4 events/patient/4-week,
P
< 0.05), and <2.5 mmol/l hypoglycaemic events were lower in insulin analogue group after 6 months. There was a trend towards a lower LI in insulin analogue group (74.3 51.3–133 vs. 123 76.4–171 mmol/l
2
/h week
−1
,
P
=
0.064). HbA
1c
and insulin dose were comparable between groups. In type 1 diabetes, insulin analogues were associated with a lower hypoglycaemic risk and a trend towards reduced glycaemic variability compared with human insulin. These effects occurred despite comparable metabolic control.
The objective of this cross-sectional study was to evaluate the impact of early diabetic nephropathy on the presence of cardiovascular disease (CVD) in a Mediterranean population, as well as the ...prevalence in these patients of traditional cardiovascular risk factors and its treatment intensity in accordance with international recommendations. In 123 patients with type 2 diabetes and incipient nephropathy the presence of CVD, smoking, hypertension, dyslipemia, and their treatment was recorded. CVD prevalence was 34%. Age, nephropathy stage (micro/macroalbuminuria), and smoking were associated with the presence of CVD. Hypertension, dyslipemia, and smoking were present in 83%, 81%, and 59%, respectively. Coexistence of several risk factors was frequent and was associated with a higher incidence of CVD. 79% hypertensive patients and 43% dyslipemic patients received pharmacological treatment but only 17% and 9%, respectively, reached a good control of their disease. Patients with known CVD showed also a deficient control. Accordingly, early diabetic nephropathy induces a multiplier effect on the cardiovascular risk of a Mediterranean population. Higher prevalence and association with cardiovascular risk factors, with smoking in a predominant role, are associated with this higher risk. Despite this, the intensity of treatment and control of these risk factors is deficient, which means that a better and more intensive treatment should reduce the morbidity and mortality in these patients.
The aim of the study was to evaluate the effects of the non-dihydropyridine calcium antagonist (NDCA) diltiazem on the development of urinary albumin excretion (UAE) in type 2 hypertensive diabetic ...patients with persistent microalbuminuria despite ACE inhibitor treatment.
Thirty-six type 2 diabetic hypertensive patients with microalbuminuria persisting after at least 1 year of treatment with ACE inhibitors were randomized to receive captopril (
n
=
22) or combined therapy with captopril and 120
mg diltiazem (
n
=
14) for 2 years. Captopril dose was individualized according to blood pressure. Changes in UAE, blood pressure, and metabolic control were monitored to analyze the influence of the addition of diltiazem on progression of diabetic nephropathy.
In patients treated with captopril and diltiazem, absolute UAE did not change during the study (baseline: 101
mg/24
h, range 39–298; 2 years after randomization: 74
mg/24
h, range 12–665). In contrast, UAE increased in patients treated with captopril monotherapy (baseline: 118
mg/24
h, range 32–282; 2 years after randomization: 164
mg/24
h, range 15–1161,
p
<
0.05). In addition, fewer patients in the captopril/diltiazem group progressed to macroalbuminuria (eight patients in captopril group and one in captopril/diltiazem group,
p
<
0.05). The beneficial effects of the addition of diltiazem were independent of blood pressure and metabolic control. We suggest that the combination of ACE inhibitors and NDCA should be considered in type 2 microalbuminuric patients at high risk for progression to established diabetic nephropathy.
