Left Ventricular Mass Reduction in Type 1 Diabetic Patients With Nephropathy

Abstract

Left ventricular hypertrophy regression was postulated more likely to occur in diabetic patients2 Reduction of LV mass and improvement in diastolic function have been observed over 12 months of intensive control of glycemia and blood pressure (BP) in patients with type 1 diabetes mellitus with proteinuria. The purpose of this study is to determine whether these improvements are dependent upon either level of renal function at the onset of treatment or stability of renal function over time. PATIENTS AND METHODSSeventeen patients (12 men, 5 women) between the ages of 21 and 65 years (mean age 41±2 years), enrolled as part of a cooperative study designed to determine whether aggressive glycemic control slowed progression of renal dysfunction in diabetic nephropathy. 3 All patients had insulin-dependent diabetes with onset before age 35; albuminuria >0.1 g/d and/or proteinuria >0.3 g/d on two separate 24-hour urine collections; creatinine clearance (CrCl) of >30 mL/min; and were without pregnancy, acute or other chronic illness (e.g., drug dependence, active liver disease, recent myocardial infarction, or stroke). All received a daily regimen of four subcutaneous injections of insulin. One half received weekly infusions of IV insulin.4 BP was assessed clinically and by quarterly ambulatory 24-hour BP

A pilot study to test the effect of pulsatile insulin infusion on cardiovascular mechanisms that might contribute to attenuation of renal compromise in type 1 diabetes mellitus patients with proteinuria

“…Improvements in glycemic control have been demonstrated to be associated with improvement of autonomic reflex responses [16,17], cardiac function [18,19], and outcome [20]. In this study, we postulated that weekly pulsatile insulin infusion would also be associated with autonomic functional, cardiac structural, and functional changes.…”

Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association

“…Intensive DM therapy has been shown to prevent the increase in resting heart rate characteristic of patients with T1DM (133), and autonomic function was significantly better in patients with intensive DM management (134). LV mass and function improve with better glycemic control (126,135,136). …”

Type 1 Diabetes Mellitus and Cardiovascular Disease

“…134 LV mass and function improve with better glycemic control. 126,135,136 Epidemiological evidence generally supports the relationship between hyperglycemia and clinical CHD events in T1DM. In a small study of 177 patients with T1DM, the incidence of CHD events over 7 years of follow-up appeared to be related to baseline HbA 1c .…”