Abstract
Background and aimsDiabetes mellitus type two is one of the major cardiovascular risk factors. Treatment of diabetes can reduce this risk, but the treatment options differ a lot in their risk-reducing capabilities. We compared the impact of insulin degludec (IDeg-100) and insulin glargine U300 (IGlar-300) on cardiovascular risk parameters - glycaemic variability (GV), arterial stiffness and lipid parameters - in insulin naive patients with DMT2.MethodsTo 23 individuals who previously had uncontrolled DMT2 on two or more oral antidiabetic drugs, IGlar-300 and IDeg-100 were applied for 12 weeks and then switched in a cross over design manner. Prior and after of each insulin phase, we analysed biochemical parameters,7-point SMBG profile over three days and arterial stiffness which was assessed indirectly by measuring the augmentation index (AIx) on the principles of applanation tonometry.ResultsThere were no significant differences between IGlar-300 and IDeg-100 regarding reduction of mean glucose values and coefficient of variation (CV). Both insulins insignificantly reduced AIx for standardised pulse of 75 beats/min and without differences between them. IGlar-300 and IDeg-100 reduced triglycerides and increased HDL with no significant difference between the two insulins. IGlar-300 increased the total cholesterol level and IDeg-100 decreased total cholesterol, but without statistically significant difference. IGlar-300 increased LDL level by 0.508 mmol/L and IDeg-100 decreased LDL by 0.217 mmol/L, with statistically significant difference (p = 0.0215).ConclusionsThis study did not show significant difference between IGlar-300 and IDeg-100 regarding glycaemic parameters and augmentation index using the same dose of 0.2 IU/kg for both insulins, but it has revealed possible differences in impact on lipid profile.Trial RegistrationClinicaltrials.gov, NCT04692415. Retrospectively registered on December 31th 2020.
Highlights
Background and aimsDiabetes mellitus type two is one of the major cardiovascular risk factors
This study did not show significant difference between IGlar-300 and IDeg-100 regarding glycaemic parameters and augmentation index using the same dose of 0.2 International units (IU)/kg for both insulins, but it has revealed possible differences in impact on lipid profile
Chronic sustained hyperglycaemia and glycaemic variability both contribute to diabetic cardiovascular complications causing excessive protein glycation and oxidative stress [4], but glycaemic variability is more specific in producing effect on oxidative stress [5], as both postprandial glucose increments and interprandial glucose decrements activate the oxidative stress [6]
Summary
Background and aimsDiabetes mellitus type two is one of the major cardiovascular risk factors. Chronic sustained hyperglycaemia and glycaemic variability both contribute to diabetic cardiovascular complications causing excessive protein glycation and oxidative stress [4] (which, worsen endothelial function indirectly), but glycaemic variability is more specific in producing effect on oxidative stress [5], as both postprandial glucose increments and interprandial glucose decrements activate the oxidative stress [6]. Arterial stiffness represents a prognostic marker of cardiovascular disease in diabetic patients and an indirect measure of target organ damage [7]. It can be measured indirectly through augmentation index (AIx), which is an indirect marker for arterial stiffness and a direct measure of wave reflection [8]
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