An "aggressive" diagnostic approach, requiring coronary angiography in asymptomatic DM2 patients with < or =1 associated RF for CAD and abnormal MCE, identified patients with a subclinical CAD characterized by a more favorable angiographic anatomy. The criterion of > or =2 RFs did not help to identify asymptomatic patients with a higher prevalence of CAD and is only related to a more severe CAD with unfavorable coronary anatomy.

In patients with diabetes and coronary artery disease, the potential negative role of sulfonylurea drugs is under intensive investigation. We assessed the effects of treatment with glibenclamide or insulin on the extension of left ventricular myocardial dysfunction induced by acute ischemia. Nineteen consecutive patients with type 2 diabetes and coronary artery disease entered the study. Each patient was randomly assigned to either insulin or glibenclamide therapy. Treatment was crossed over after 12 weeks and maintained for another 12 weeks. At the end of each treatment, left ventricular myocardial function at rest and during dipyridamole infusion was studied by two-dimensional echocardiography under the same conditions of metabolic control.

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OBJECTIVE -Postprandial glycemia is an independent risk factor for cardiovascular disease that is more powerful than fasting glycemia and determines myocardial perfusion defects in type 2 diabetes. We examined the efficacy of two different insulin regimes (regular insulin and insulin analog) in controlling postprandial hyperglycemia and in preventing myocardial perfusion abnormalities. RESEARCH DESIGN AND METHODS-A total of 20 consecutive type 2 diabetic patients and 20 control subjects were enrolled in this randomized, three-way, cross-over, placebocontrolled study. Myocardial perfusion was assessed by myocardial contrast echocardiography (MCE) in fasting and postprandial (120 min) state.RESULTS -Insulin analog was associated with lower, but not statistically significant, postprandial glycemia than regular insulin (glucose increase: 116 Ϯ 8 vs. 136 Ϯ 5%, P ϭ NS). However, the area under the curve following insulin analog was significantly lower than regular insulin (18,354 Ϯ 702 vs. 20,757 Ϯ 738 mg per 120 min, P ϭ 0.032). D iabetes is associated with a markedly increased risk of cardiovascular disease (CVD), and this excess risk is not explained by the increase of conventional cardiovascular risk factors (1). Several studies confirmed that tight glycemic control reduces and delays late diabetes and microvascular complications (2,3). Considerable data indicate that postprandial plasma glucose level might be an independent risk factor of CVD that is more powerful than fasting hyperglycemia, and the presence of postprandial hyperglycemia is a significant predictor of myocardial infarction and death (4). Recently, the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study confirmed that postload hyperglycemia increases mortality and that postload glucose is a better predictor of mortality than fasting glucose (5). Postprandial hyperglycemia could result in labile nonenzymatic glycation, promotion of thrombosis, and production of free radicals that could generate tissue damage and favor the development of micro-and macrovascular complications (6). In a recent study including type 2 diabetic patients, postprandial hyperglycemia determined myocardial perfusion defects secondary to deterioration in microvascular function (7). Thus, clinically it seems reasonable to avoid excessive postprandial hyperglycemia in the management of diabetes (8).The present study was conducted to compare the efficacy of two different insulin regimes (regular insulin or insulin analog) in controlling postprandial hyperglycemia and preventing myocardial perfusion defects in type 2 diabetic patients.RESEARCH DESIGN AND METHODS -Among type 2 diabetic patients regularly attending the Diabetes Clinic of University of Padua, we enrolled 20 consecutive patients with a diagnosis of type 2 diabetes for Ն6 months but Յ10 years, aged Յ60 years, with a BMI of 26.4 Ϯ 1.4 and HbA 1c (A1C) of 7.2 Ϯ 1%. All patients were managed by dietary therapy. Exclusion criteria included any hepatic disease, renal disease (plasma...

Background-In diabetic patients, postprandial hyperglycemia is a more powerful risk factor for cardiovascular disease than fasting hyperglycemia itself. A negative influence of acute hyperglycemia on systemic endothelial function (brachial artery) has been shown. However, myocardial perfusion during postprandial hyperglycemia has not been investigated.

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Background: With advancing age the risk of developing serious nutritional deficiencies increases, and disturbances to the actions of insulin and insulin-like growth factor, coupled with reduced protein/amino acid (AA) intake, impair protein synthesis in muscles. Objective: To assess the effects of administering oral AAs on walking capacity and perceived walking impairment, isometric muscular strength, and myocardial function at rest and during isometric exercise. Methods: One hundred elderly subjects (aged >65 years) with reduced physical activity were randomized to receive an oral AA mixture (12 g/day) or placebo for 3 months. At baseline and after 3 months of therapy we assessed physical capacity with the 6-min walk test, and perceived physical impairment with the walking impairment questionnaire (WIQ); we assessed maximal isometric muscular strength of the right hand with a handgrip dynamometer, and left ventricular ejection fraction (LVEF) using quantitative two-dimensional echocardiography at rest and during acute overload. Results: Three months of AA treatment resulted in significant increases in 6-min walk distance (268.8 ± 34.9 vs. 212 ± 40 m, p < 0.001), WIQ scores (distance: 68.3 ± 12 vs. 53 ± 14.8%, p < 0.001; speed: 72.2 ± 14.4 vs. 52.8 ± 12%, p < 0.001; stairs: 98.2 ± 24 vs. 72.4 ± 22%, p < 0.001), and in maximal muscular isometric strength (20.2 ± 2 vs. 14 ± 2.8 kg, p < 0.001). Moreover, peak stress LVEF was higher during AA administration when compared to placebo administration (67 ± 7 vs. 56 ± 9%, p < 0.01). Left ventricular response to exercise normalized during AA administration in 24 out of 32 (75%) patients with abnormal LV response at baseline, whereas it remained unchanged in the placebo group. Conclusion: An oral AA supply such as that used in this study improves ambulatory capacity, maximal isometric muscle strength and myocardial ability to match an acute overload in elderly subjects without affecting the main metabolic parameters. These functional gains may translate into increased perceived walking capacity.

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